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WALGREENS SPECIALTY PHARMACY, LLC
DSH320022 PLAINS REGIONAL MEDICAL CENTER - CLOVIS
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Covered Entity Details
Entity Name
PLAINS REGIONAL MEDICAL CENTER - CLOVIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320022
Entity Address
2100 NORTH DR MARTIN LUTHER KING JR BLVD
CLOVIS, NM 88101
Medicare Provider Number
320022
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
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
4/17/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DALE MAXWELL, SENIOR VP & CFO
(505) 923-5353
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/17/2013
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