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WALGREENS SPECIALTY PHARMACY, LLC
CAH181329-00 SAINT JOSEPH BEREA HOSPITAL
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Covered Entity Details
Entity Name
SAINT JOSEPH BEREA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181329-00
Entity Address
305 ESTILL STREET
BEREA, KY 40403
Medicare Provider Number
181329
Participating Start Date
9/30/2010
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
1/17/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/18/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sandra Rose, Vice President of Operations
(859) 986-6559
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2018
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