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WALGREENS SPECIALTY PHARMACY, LLC
SCH140058-00 Jacksonville Memorial Hospital
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Covered Entity Details
Entity Name
Jacksonville Memorial Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140058-00
Entity Address
1600 WEST WALNUT
JACKSONVILLE, IL 62650-1185
Medicare Provider Number
140058
Participating Start Date
10/1/2017
Last Recertification Date
9/15/2021
Entity Termination Date
7/7/2022
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
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/7/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Harry Schmidt, President and CEO
(217) 479-5898
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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