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WALGREENS SPECIALTY PHARMACY, LLC
RRC340050-00 SOUTHEASTERN REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHEASTERN REGIONAL MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC340050-00
Entity Address
300 W. 27TH STREET
LUMBERTON, NC 28358-3075
Medicare Provider Number
340050
Participating Start Date
1/1/2014
Last Recertification Date
9/8/2016
Entity Termination Date
10/1/2016
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
10/22/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joann Anderson, President/CEO
(910) 671-5177
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/22/2015
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