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WALGREEN CO.
DSH050276 CONTRA COSTA REGIONAL MEDICAL CENTER
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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 #15946
3614 MT DIABLO BLVD
LAFAYETTE, CA 94549
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
4/2/2024
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
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