Contract Pharmacy Details

WALGREEN CO.
DSH500044 DEACONESS MEDICAL CENTER

Covered Entity Details

Entity Name

DEACONESS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500044

Entity Address

800 W 5TH AVENUE
SPOKANE, WA 99204

Medicare Provider Number

500044

Participating Start Date

1/1/2019

Last Recertification Date

8/18/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16403
1409 11TH AVE.
SEATTLE, WA 98122

Pharmacy Comments

Contract Details

Approval Date

1/15/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Wendy Hunter Apland, Chief Financial Officer
(509) 473-7961

Contract Pharmacy Representative

Walgreens
Erin Kayser, Health Systems Solutions Director
(949) 280-7219

Signed By Date

1/15/2019

340B Drug Pricing Program Database