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WALGREENS SPECIALTY PHARMACY, LLC
SCH130002-00 St. Luke's Magic Valley Regional Medical Center, LTD
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Covered Entity Details
Entity Name
St. Luke's Magic Valley Regional Medical Center, LTD
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH130002-00
Entity Address
801 Pole Line Rd.West
Twin Falls, ID 83301
Medicare Provider Number
130002
Participating Start Date
7/1/2013
Last Recertification Date
8/14/2024
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
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2018
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