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WALGREENS SPECIALTY PHARMACY, LLC
DSH250006 BAPTIST MEMORIAL HOSPITAL - UNION COUNTY
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL - UNION COUNTY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250006
Entity Address
200 STATE HIGHWAY 30 W
NEW ALBANY, MS 38652-3112
Medicare Provider Number
250006
Participating Start Date
9/4/2008
Last Recertification Date
8/26/2024
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
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/5/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
WALTER GRACE, CEO AND ADMINISTRATOR
(662) 538-2100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2014
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