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WALGREEN CO.
DSH500139 CAPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CAPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500139
Entity Address
3900 CAPITAL MALL DRIVE SW
OLYMPIA, WA 98502
Medicare Provider Number
500139
Participating Start Date
7/1/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12453
702 TROSPER RD. SW
TUMWATER, WA 98512-6934
Pharmacy Comments
Contract Details
Approval Date
6/7/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2022
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