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WALGREENS SPECIALTY PHARMACY, LLC
CAH201307-00 MILLINOCKET REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MILLINOCKET REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201307-00
Entity Address
200 SOMERSET STREET
MILLINOCKET, ME 04462
Medicare Provider Number
201307
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
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
7/22/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary K. Martin, VP of Quality
(207) 723-5161 Ext: 370
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2018
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