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WALGREENS SPECIALTY PHARMACY, LLC
CAH281342-00 SAINT MARY'S HOSPITAL d/b/a CHI Health St Mary's
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Covered Entity Details
Entity Name
SAINT MARY'S HOSPITAL d/b/a CHI Health St Mary's
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281342-00
Entity Address
1301 Grundman BLVD
NEBRASKA CITY, NE 68410
Medicare Provider Number
281342
Participating Start Date
9/22/2010
Last Recertification Date
8/21/2024
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
1/23/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/6/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel J. Kelly, President
(402) 873-8901
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/23/2018
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