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WALGREENS SPECIALTY PHARMACY, LLC
RW424848 Children's Hospital of Philadelphia
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Covered Entity Details
Entity Name
Children's Hospital of Philadelphia
Subdivision Name
Adolescent Initiative
Type
Ryan White Part D
340B ID
RW424848
Entity Address
3550 Market St.
5th Floor
Philadelphia, PA 19104
Grant Number
H12HA24848
Participating Start Date
7/1/2015
Last Recertification Date
2/19/2025
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
THOMAS J. TODOROW, EXECUTIVE VICE PRESIDENT FINANCE AND CHIEF FINANCIAL OFFICER
(267) 426-6957
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2015
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