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WALGREENS SPECIALTY PHARMACY, LLC
DSH500044 DEACONESS MEDICAL CENTER
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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
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
8325 S. PARK CIRCLE
SUITE 200
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2019
Agreement registered in error
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
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