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OAK GROVE PHARMACY
DSH050180 JOHN MUIR MEDICAL CENTER - WC
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Covered Entity Details
Entity Name
JOHN MUIR MEDICAL CENTER - WC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050180
Entity Address
1601 YGNACIO VALLEY ROAD
WALNUT CREEK, CA 94598-3198
Medicare Provider Number
050180
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
OAK GROVE PHARMACY
Pharmacy Address
785 OAK GROVE RD STE G2
CONCORD, CA 94518-3605
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Zach Harris, VP Ancillary Services
(808) 457-0157
Contract Pharmacy Representative
Oak Grove Pharmacy
Naser Kalil, Owner
(925) 681-1823
Signed By Date
10/11/2024
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