Contract Pharmacy Details

WALGREEN CO.
DSH230230 EDWARD W SPARROW HOSPITAL ASSOCIATION

Covered Entity Details

Entity Name

EDWARD W SPARROW HOSPITAL ASSOCIATION

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230230

Entity Address

1215 E MICHIGAN AVE
LANSING, MI 48912

Medicare Provider Number

230230

Participating Start Date

10/1/2004

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06369
410 E JOLLY ROAD
LANSING, MI 48910-6649

Pharmacy Comments

Contract Details

Approval Date

7/30/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

PAULA M. REICHLE, SR VP AND CFO
(517) 364-5400

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/30/2014

340B Drug Pricing Program Database