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WALGREENS SPECIALTY PHARMACY, LLC
DSH160047 JENNIE EDMUNDSON MEMORIAL
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Covered Entity Details
Entity Name
JENNIE EDMUNDSON MEMORIAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160047
Entity Address
933 EAST PIERCE STREET
COUNCIL BLUFFS, IA 51503
Medicare Provider Number
160047
Participating Start Date
1/1/2016
Last Recertification Date
8/18/2024
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
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven P. Baumert, President and CEO
(712) 396-6222
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2016
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