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WALGREENS SPECIALTY PHARMACY, LLC
SCH160013-00 UNITY HEALTHCARE D/B/A TRINITY MUSCATINE
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Covered Entity Details
Entity Name
UNITY HEALTHCARE D/B/A TRINITY MUSCATINE
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH160013-00
Entity Address
1518 MULBERRY AVE
MUSCATINE, IA 52761
Medicare Provider Number
160013
Participating Start Date
7/1/2012
Last Recertification Date
9/10/2020
Entity Termination Date
10/1/2021
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
4/8/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/5/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dave Dellitt, Chief Financial Officer
(309) 779-2218
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/8/2016
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