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WALGREEN CO.
DSH500119 VALLEY HOSPITAL & MEDICAL CENTER
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Covered Entity Details
Entity Name
VALLEY HOSPITAL & MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500119
Entity Address
12606 E MISSION Ave
SPOKANE Valley, WA 99216
Medicare Provider Number
500119
Participating Start Date
10/1/2019
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15643
910 W. FIFTH AVENUE
SUITE 270
SPOKANE, WA 99204
Pharmacy Comments
Contract Details
Approval Date
10/16/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/24/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Walgreens
Erin Kayser, Health Systems Solutions Director
(949) 280-7219
Signed By Date
10/16/2019
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