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WALGREENS SPECIALTY PHARMACY, LLC
DSH050455 Adventist Health Bakersfield
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Covered Entity Details
Entity Name
Adventist Health Bakersfield
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050455
Entity Address
2615 Chester Avenue
BAKERSFIELD, CA 93301
Medicare Provider Number
050455
Participating Start Date
4/1/2005
Last Recertification Date
9/4/2024
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
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/16/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Douglas Duffield, CEO
(661) 869-6180
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2014
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