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WALGREEN CO.
CAH231333-00 ASPIRUS IRONWOOD HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS IRONWOOD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231333-00
Entity Address
N10561 GRAND VIEW LANE
IRONWOOD, MI 49938
Medicare Provider Number
231333
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10758
110 LAKE SHORE DR. W
ASHLAND, WI 54806-1645
Pharmacy Comments
Contract Details
Approval Date
4/18/2012
Contract Begin Date
4/18/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHARMAINE CHIANTELLO, CFO
(906) 932-2525 Ext: 6012
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2012
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