Contract Pharmacy Details

WALGREEN CO.
DSH380051 Salem Health

Covered Entity Details

Entity Name

Salem Health

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH380051

Entity Address

890 Oak Street SE
Salem, OR 97301

Medicare Provider Number

380051

Participating Start Date

7/1/2012

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12095
1000 N. EVERGREEN RD.
WOODBURN, OR 97071

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Josh Free, Chief Pharmacy Officer
(503) 814-2773

Contract Pharmacy Representative

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

Signed By Date

10/15/2020

340B Drug Pricing Program Database