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WALGREENS SPECIALTY PHARMACY, LLC
SCH200037-00 Franklin Memorial Hospital
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Covered Entity Details
Entity Name
Franklin Memorial Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH200037-00
Entity Address
111 Franklin Health Commons
Farmington, ME 04938
Medicare Provider Number
200037
Participating Start Date
7/1/2017
Last Recertification Date
9/5/2023
Entity Termination 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
Contract Termination Date
Termination Reason
8/20/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John W. Cox, Regional Chief Financial Officer
(207) 744-6024
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2018
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