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WALGREEN CO.
DSH050276E CONTRA COSTA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CONTRA COSTA REGIONAL MEDICAL CENTER
Subdivision Name
ANTIOCH HEALTH CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050276E
Entity Address
ANTIOCH HEALTH CENTER
2335 Country Hills Drive
ANTIOCH, CA 94509-7319
Medicare Provider Number
050276
Outpatient Facility Provider Number
Participating Start Date
4/1/2007
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04491
15650 SAN PABLO AVE.
SAN PABLO, CA 94806
Pharmacy Comments
Contract Details
Approval Date
3/21/2011
Contract Begin Date
3/21/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/25/2011
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