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WALGREENS SPECIALTY PHARMACY, LLC
CAH181325-02 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
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Covered Entity Details
Entity Name
JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
Subdivision Name
GREEN COUNTY PRIMARY CARE
Type
Critical Access Hospital
340B ID
CAH181325-02
Entity Address
310 Industrial Park Road
GREENSBURG, KY 42743
Medicare Provider Number
181325
Outpatient Facility Provider Number
183455
Participating Start Date
7/1/2011
Last Recertification Date
8/30/2024
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
1/18/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
REX A. TUNGATE, CEO
(270) 932-9696 Ext: 22
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/18/2018
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