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WALGREENS SPECIALTY PHARMACY, LLC
CAH181301-00 Marcum & Wallace Memorial Hospital
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Covered Entity Details
Entity Name
Marcum & Wallace Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181301-00
Entity Address
60 Mercy Ct
Irvine, KY 40336
Medicare Provider Number
181301
Participating Start Date
7/1/2012
Last Recertification Date
8/29/2024
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
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/8/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lori Witt, CFO
(606) 726-6507
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2018
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