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WALGREENS SPECIALTY PHARMACY, LLC
CAH521354-00 SOUTHWEST HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTHWEST HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521354-00
Entity Address
1400 EAST SIDE ROAD
PLATTEVILLE, WI 53818
Medicare Provider Number
521354
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
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
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Rohrbach, CEO
(608) 342-4701
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2016
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