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WALGREENS SPECIALTY PHARMACY, LLC
SCH380001-00 Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge
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Covered Entity Details
Entity Name
Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH380001-00
Entity Address
1700 E 19TH STREET
THE DALLES, OR 97058-3398
Medicare Provider Number
380001
Participating Start Date
9/28/2010
Last Recertification Date
8/27/2024
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
10/19/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DONALD ARBON, V.P. FINANCE/CFO
(541) 296-7524
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/19/2015
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