Contract Pharmacy Details

WALGREEN CO.
CH05039B NORTHWEST MICHIGAN HEALTH SERVICES, INC

Covered Entity Details

Entity Name

NORTHWEST MICHIGAN HEALTH SERVICES, INC

Subdivision Name

Northwest Michigan Health Services, Inc.

Type

HRSA-Funded Health Center

340B ID

CH05039B

Entity Address

119 S State St
Shelby, MI 49455-1243

Grant Number

H80CS00669

Participating Start Date

4/1/2002

Last Recertification Date

2/28/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12894
975 W SOUTH AIRPORT ROAD
TRAVERSE CITY, MI 49686-4846

Pharmacy Comments

Contract Details

Approval Date

4/9/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Heidi Britton, Chief Executive Officer
(231) 947-1112

Contract Pharmacy Representative

Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116

Signed By Date

4/9/2025

340B Drug Pricing Program Database