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WALGREEN CO.
DSH230230 EDWARD W SPARROW HOSPITAL ASSOCIATION
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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 #13150
812 E. SAGINAW HWY
GRAND LEDGE, MI 48837
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
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
10/15/2015
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