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WALGREENS SPECIALTY PHARMACY, LLC
DSH330136 MARY IMOGENE BASSETT HOSPITAL
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Covered Entity Details
Entity Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330136
Entity Address
1 ATWELL ROAD
COOPERSTOWN, NY 13326
Medicare Provider Number
330136
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
4/29/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Vielkind, Vice President Finance
(315) 823-5281
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2025
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