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WALGREENS SPECIALTY PHARMACY, LLC
DSH050121 Adventist Medical Center
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Covered Entity Details
Entity Name
Adventist Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050121
Entity Address
115 mall drive
HANFORD, CA 93230
Medicare Provider Number
050121
Participating Start Date
1/1/2008
Last Recertification Date
9/6/2024
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
7/23/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/4/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David L. Larsen, SR VP CFO
(559) 537-0050
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/23/2014
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