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WALGREENS SPECIALTY PHARMACY, LLC
CAH511303-00 Minnie Hamilton Health Care Center, INC
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Covered Entity Details
Entity Name
Minnie Hamilton Health Care Center, INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511303-00
Entity Address
186 Hospital Dr
Grantsville, WV 26147-7100
Medicare Provider Number
511303
Participating Start Date
4/1/2014
Last Recertification Date
8/16/2024
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
4/5/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen Whited, CEO
(304) 354-9244 Ext: 5183
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/5/2018
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