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WALGREEN CO.
DSH050444 MERCY MEDICAL CENTER MERCED
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER MERCED
Subdivision Name
COMMUNITY CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH050444
Entity Address
333 MERCY AVE
MERCED, CA 95340
Medicare Provider Number
050444
Participating Start Date
7/1/1994
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03330
1640 R STREET
MERCED, CA 95340
Pharmacy Comments
Contract Details
Approval Date
7/16/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/5/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Strasser, CFO
(209) 564-5003
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2013
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