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WALGREENS SPECIALTY PHARMACY, LLC
DSH050367 NorthBay Healthcare Group
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Covered Entity Details
Entity Name
NorthBay Healthcare Group
Subdivision Name
NORTH BAY MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050367
Entity Address
1200 B GALE WILSON BLVD
FAIRFIELD, CA 94533
Medicare Provider Number
050367
Participating Start Date
7/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ART DENIO, CFO
(707) 646-3111
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2015
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