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WALGREEN CO.
DSH050196 Central Valley General Hospital
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Covered Entity Details
Entity Name
Central Valley General Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050196
Entity Address
1025 N. Douty Street
Hanford, CA 93230
Medicare Provider Number
050196
Participating Start Date
1/1/2008
Last Recertification Date
8/17/2016
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09815
988 SIERRA STREET
KINGSBURG, CA 93631
Pharmacy Comments
Contract Details
Approval Date
7/24/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Wayne Ferch, President & CEO
(559) 537-0053
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/24/2014
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