Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
SCH240088-00 Rice Memorial Hospital

Covered Entity Details

Entity Name

Rice Memorial Hospital

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH240088-00

Entity Address

301 Becker Ave. SW
Willmar, MN 56201

Medicare Provider Number

240088

Participating Start Date

10/1/2011

Last Recertification Date

11/16/2017

Entity Termination Date

6/25/2018

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

4/4/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

William Fenske, Chief Financial Officer
(320) 231-4009

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/4/2016

340B Drug Pricing Program Database