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WALGREENS SPECIALTY PHARMACY, LLC
DSH180025 ST. JOE. - FLAGET
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Covered Entity Details
Entity Name
ST. JOE. - FLAGET
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180025
Entity Address
4305 NEW SHEPHERDSVILLE RD
BARDSTOWN, KY 40004
Medicare Provider Number
180025
Participating Start Date
4/1/2016
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
4/6/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/7/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard J Vancise, VP-Hospital Operations
(502) 350-5456
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/6/2018
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