340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREENS SPECIALTY PHARMACY, LLC
DSH160122 Fort Madison Community Hospital
Print
Covered Entity Details
Entity Name
Fort Madison Community Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160122
Entity Address
5445 Avenue O
Fort Madison, IA 52627
Medicare Provider Number
160122
Participating Start Date
7/1/2014
Last Recertification Date
8/17/2020
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
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brad Kokjohn, CFO
(319) 376-2125
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2016
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session