Contract Pharmacy Details

WALGREEN CO.
DSH500044E DEACONESS MEDICAL CENTER

Covered Entity Details

Entity Name

DEACONESS MEDICAL CENTER

Subdivision Name

DEM ACI-DHEC - Radiology-Diagnostic

Type

Disproportionate Share Hospital

340B ID

DSH500044E

Entity Address

910 W. 5th Ave., Suite 901
Spokane, WA 99204

Medicare Provider Number

500044

Outpatient Facility Provider Number

Participating Start Date

1/1/2019

Last Recertification Date

8/18/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15643
910 W. FIFTH AVENUE
SUITE 270
SPOKANE, WA 99204

Pharmacy Comments

Contract Details

Approval Date

4/2/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/10/2019
Agreement registered in error

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/2/2019

340B Drug Pricing Program Database