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WALGREEN CO.
RRC050567-00 MISSION HOSPITAL REG MEDICAL CENTER
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Covered Entity Details
Entity Name
MISSION HOSPITAL REG MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC050567-00
Entity Address
27700 MEDICAL CENTER ROAD
MISSION VIEJO, CA 92691
Medicare Provider Number
050567
Participating Start Date
1/1/2021
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06446
11900 BEACH BLVD
STANTON, CA 90680
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/26/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Eileen Haubl, Chief Financial Officer
(949) 364-1400 Ext: 5408
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2023
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