Contract Pharmacy Details

WALGREEN CO
DSH230207 McLaren Oakland

Covered Entity Details

Entity Name

McLaren Oakland

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230207

Entity Address

50 NORTH PERRY
PONTIAC, MI 48342

Medicare Provider Number

230207

Participating Start Date

1/1/2005

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #09928
20 S TELEGRAPH RD
WATERFORD, MI 48328

Pharmacy Comments

Contract Details

Approval Date

4/5/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

FRED KORTE, CFO
(248) 338-5691

Contract Pharmacy Representative

McLaren Health Care
Sharelle Brown, Corporate, 340B Program Director
(248) 396-8085

Signed By Date

4/5/2016

340B Drug Pricing Program Database