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WALGREEN CO.
DSH050047 SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
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Covered Entity Details
Entity Name
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
Subdivision Name
CALIFORNIA PACIFIC MEDICAL CENTER PACIFIC CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH050047
Entity Address
1101 VAN NESS AVE
SAN FRANCISCO, CA 94109
Medicare Provider Number
050047
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16533
1100 VAN NESS AVE STE C
SAN FRANCISCO, CA 94109
Pharmacy Comments
Contract Details
Approval Date
4/16/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
HENRY YU, VP AND CFO
(415) 600-3850
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2019
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