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WALGREENS SPECIALTY PHARMACY, LLC
CAH381312-00 COQUILLE VALLEY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
COQUILLE VALLEY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381312-00
Entity Address
940 E. 5th Street
COQUILLE, OR 97423
Medicare Provider Number
381312
Participating Start Date
4/1/2018
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16287
130 ENTERPRISE DR
PITTSBURGH, PA 15275
Pharmacy Comments
Contract Details
Approval Date
4/27/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey M. Lang, CEO
(541) 396-1052
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/27/2020
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