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WALGREEN CO.
SCH230058-00 MUNSON HEALTHCARE GRAYLING HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE GRAYLING HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230058-00
Entity Address
1100 E Michigan Ave
GRAYLING, MI 49738
Medicare Provider Number
230058
Participating Start Date
4/1/2024
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11689
2045 S I75 BUSINESS LOOP
GRAYLING, MI 49738
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mary Jo Schrank, Director of Finance
(989) 348-0096
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2015
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