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WALGREEN CO.
CAH501314-00 Ocean Beach Hospital
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Covered Entity Details
Entity Name
Ocean Beach Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501314-00
Entity Address
174 First Ave N
Ilwaco, WA 98624
Medicare Provider Number
501314
Participating Start Date
1/1/2012
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09671
1625 E HARBOR DR
WARRENTON, OR 97146
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry Jay Cohen, CEO
(360) 642-6300
Contract Pharmacy Representative
Walgreen Co
Bradley Hedstrom, Account Manager Health Systems
(224) 515-6021
Signed By Date
1/14/2022
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