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WALGREEN CO.
DSH500036 YAKIMA VALLEY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
YAKIMA VALLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500036
Entity Address
2811 TIETON DR.
YAKIMA, WA 98902
Medicare Provider Number
500036
Participating Start Date
12/1/1992
Last Recertification Date
8/17/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12275
610 W. YAKIMA AVE.
YAKIMA, WA 98902
Pharmacy Comments
Contract Details
Approval Date
4/19/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Reed, CFO
(509) 574-5965
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/19/2019
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