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WALGREENS SPECIALTY PHARMACY, LLC
DSH110107 Atrium Health Navicent The Medical Center
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Covered Entity Details
Entity Name
Atrium Health Navicent The Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110107
Entity Address
777 HEMLOCK ST.
MACON, GA 31201-2102
Medicare Provider Number
110107
Participating Start Date
12/1/1992
Last Recertification Date
9/4/2024
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
1/10/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Susan Harris, COO
(478) 633-1452
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/10/2018
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