Contract Pharmacy Details

WALGREEN CO.
DSH050115 PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)

Covered Entity Details

Entity Name

PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050115

Entity Address

2185 Citracado Parkway
Escondido, CA 92029

Medicare Provider Number

050115

Participating Start Date

4/1/2006

Last Recertification Date

9/10/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 09389
310 SYCAMORE AVENUE
VISTA, CA 92083-7702

Pharmacy Comments

Contract Details

Approval Date

12/17/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/12/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

ROBERT A. HEMKER, CFO
(858) 675-5567

Contract Pharmacy Representative

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

Signed By Date

10/29/2012

340B Drug Pricing Program Database