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WALGREENS SPECIALTY PHARMACY, LLC
CAH511300-00 Broaddus Hospital Association, Inc. DBA Broaddus Hospital
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Covered Entity Details
Entity Name
Broaddus Hospital Association, Inc. DBA Broaddus Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511300-00
Entity Address
# 1 HEALTHCARE DRIVE
PHILIPPI, WV 26416
Medicare Provider Number
511300
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
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
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DANA GOULD, CEO
(304) 457-8155
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2018
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