Contract Pharmacy Details

WALGREEN CO.
DSH050315 KERN MEDICAL CENTER

Covered Entity Details

Entity Name

KERN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050315

Entity Address

1700 MT. VERNON AVE.
BAKERSFIELD, CA 93306

Medicare Provider Number

050315

Participating Start Date

10/1/1995

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06526
9550 HAGEMAN ROAD
BAKERSFIELD, CA 93312

Pharmacy Comments

Contract Details

Approval Date

10/10/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Russell V Judd, Chief Executive Officer
(661) 326-2102

Contract Pharmacy Representative

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

Signed By Date

10/10/2021

340B Drug Pricing Program Database