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WALGREENS SPECIALTY PHARMACY, LLC
DSH240036 ST. CLOUD HOSPITAL
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Covered Entity Details
Entity Name
ST. CLOUD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240036
Entity Address
1406 6TH AVENUE NORTH
Saint Cloud, MN 56303
Medicare Provider Number
240036
Participating Start Date
7/1/2016
Last Recertification Date
8/28/2024
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
7/13/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greg Klugherz, CFO
(320) 255-5655
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2017
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