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WALGREENS.COM, INC.
DSH380038 PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER
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Covered Entity Details
Entity Name
PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380038
Entity Address
1500 DIVISION STREET
OREGON CITY, OR 97045
Medicare Provider Number
380038
Participating Start Date
7/1/2015
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREENS.COM, INC.
Pharmacy Address
DBA: WALGREENS
2225 S. PRICE ROAD
CHANDLER, AZ 85286
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell P. Reinhard, Chief Executive
(503) 657-6915
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2019
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