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WALGREENS SPECIALTY PHARMACY, LLC
CAH241370-00 ST. GABRIEL'S HOSPITAL
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Covered Entity Details
Entity Name
ST. GABRIEL'S HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241370-00
Entity Address
815 SE 2nd Street.
LITTLE FALLS, MN 56345
Medicare Provider Number
241370
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
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
7/19/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/6/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
STEVEN SMITH, President
(320) 631-5600
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/19/2017
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