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WALGREEN CO.
CAH521358-00 DOOR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DOOR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521358-00
Entity Address
323 SOUTH 18TH AVENUE
STURGEON BAY, WI 54235
Medicare Provider Number
521358
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07635
808 S DULUTH AVE
STURGEON BAY, WI 54235-3807
Pharmacy Comments
Contract Details
Approval Date
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROBERT C. SCIESZINSKI, CFO
(920) 746-3636
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2014
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