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WALGREEN CO
DSH050084 ST JOSEPH'S MEDICAL CENTER
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Covered Entity Details
Entity Name
ST JOSEPH'S MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050084
Entity Address
1800 N CALIFORNIA STREET
STOCKTON, CA 95204
Medicare Provider Number
050084
Participating Start Date
1/1/2005
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10482
7850 WEST LANE
STOCKTON, CA 95210
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/10/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald J Wiley, President and CEO
(209) 467-6384
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2019
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