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WALGREEN CO.
DSH230021 LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS
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Covered Entity Details
Entity Name
LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS
Subdivision Name
LAKELAND HOSPITAL - ST JOSEPH
Type
Disproportionate Share Hospital
340B ID
DSH230021
Entity Address
1234 NAPIER AVENUE
ST JOSEPH, MI 49085
Medicare Provider Number
230021
Participating Start Date
10/1/2004
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03364
907 SOUTH 11TH ST
NILES, MI 49120
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TIM CALHOUN, CFO
(269) 983-8398
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2014
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