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WALGREENS SPECIALTY PHARMACY, LLC
DSH100063 MORTON PLANT NORTH BAY HOSPITAL
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Covered Entity Details
Entity Name
MORTON PLANT NORTH BAY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100063
Entity Address
6600 MADISON STREET
NEW PORT RICHEY, FL 34652-1971
Medicare Provider Number
100063
Participating Start Date
1/1/2015
Last Recertification Date
8/26/2024
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
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2015
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