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WALGREENS SPECIALTY PHARMACY, LLC
DSH050107 MARIAN MEDICAL CENTER
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Covered Entity Details
Entity Name
MARIAN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050107
Entity Address
1400 E CHURCH ST
SANTA MARIA, CA 93454
Medicare Provider Number
050107
Participating Start Date
1/1/2005
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
10/13/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/10/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SUE ANDERSEN, CFO
(805) 739-3110
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2019
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