Contract Pharmacy Details

WALGREEN CO.
DSH050276 CONTRA COSTA REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

CONTRA COSTA REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050276

Entity Address

Contra Costa Regional Medical Center
2500 ALHAMBRA AVE.
MARTINEZ, CA 94553-3156

Medicare Provider Number

050276

Participating Start Date

4/1/1998

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 02485
21001 SAN RAMON VALLEY BLVD
SAN RAMON, CA 94583

Pharmacy Comments

Contract Details

Approval Date

10/14/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/7/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

PATRICK GODLEY, COO & CFO
(925) 957-5405

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/14/2019

340B Drug Pricing Program Database