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WALGREENS SPECIALTY PHARMACY, LLC
DSH050060 COMMUNITY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050060
Entity Address
2823 FRESNO STREET
FRESNO, CA 93721
Medicare Provider Number
050060
Participating Start Date
4/1/2007
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
10/4/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/25/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOSEPH M. NOWICKI, CFO
(559) 324-4780
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/4/2016
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