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WALGREEN CO
CAH231332-00 BRONSON LAKEVIEW HOSPITAL
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Covered Entity Details
Entity Name
BRONSON LAKEVIEW HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231332-00
Entity Address
408 HAZEN STREET
PAW PAW, MI 49079
Medicare Provider Number
231332
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12688
848 S KALAMAZOO ST
PAW PAW, MI 49079-9230
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James B. Falahee Jr., Sr. Vice President, Legal & Legislative Affairs
(269) 341-8907
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2015
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