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WALGREENS SPECIALTY PHARMACY, LLC
DSH070003 Day Kimball Hospital
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Covered Entity Details
Entity Name
Day Kimball Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070003
Entity Address
320 Pomfret Street
Putnam, CT 06260-1869
Medicare Provider Number
070003
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
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
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul A. Beaudoin, Chief Financial Officer
(860) 928-6541 Ext: 2113
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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