Contract Pharmacy Details

WALGREENS.COM, INC.
CAH051333-00 Ridgecrest Regional Hospital

Covered Entity Details

Entity Name

Ridgecrest Regional Hospital

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH051333-00

Entity Address

1081 N. China Lake Blvd.
Ridgecrest, CA 93555

Medicare Provider Number

051333

Participating Start Date

10/1/2013

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREENS.COM, INC.

Pharmacy Address

WALGREENS #02445
8337 S PARK CIRCLE
ORLANDO, FL 32819

Pharmacy Comments

Contract Details

Approval Date

4/9/2021

Contract Begin Date

4/19/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/20/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

James Suver, CEO
(760) 499-3902

Contract Pharmacy Representative

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

Signed By Date

4/9/2021

340B Drug Pricing Program Database