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WALGREEN CO.
DSH230035 Corewell Health Greenville Hospital
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Covered Entity Details
Entity Name
Corewell Health Greenville Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230035
Entity Address
615 S. BOWER STREET
GREENVILLE, MI 48838
Medicare Provider Number
230035
Participating Start Date
1/20/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04299
2829 DIVISION AVE S.
WYOMING, MI 49548
Pharmacy Comments
Contract Details
Approval Date
10/26/2012
Contract Begin Date
10/26/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/25/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Priscilla Kay Mahar, Chief Operating and Compliance Officer
(616) 225-6313
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
9/28/2012
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