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WALGREENS SPECIALTY PHARMACY, LLC
DSH240040 Range Regional Health Services
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Covered Entity Details
Entity Name
Range Regional Health Services
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240040
Entity Address
750 E 34th Street
Hibbing, MN 55746
Medicare Provider Number
240040
Participating Start Date
10/1/2011
Last Recertification Date
8/23/2024
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
4/19/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patrick Sharp, CEO
(218) 362-6730
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/19/2018
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