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WALGREEN CO.
DSH230022 COMMUNITY HEALTH CENTER BRANCH CTY
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER BRANCH CTY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230022
Entity Address
274 EAST CHICAGO STREET
COLDWATER, MI 49036
Medicare Provider Number
230022
Participating Start Date
4/1/2018
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09146
950 S CENTERVILLE RD
STURGIS, MI 49091-2089
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randy DeGroot, CEO
(517) 279-5489
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2018
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