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WALGREEN CO.
DSH050590 METHODIST HOSPITAL OF SACRAMENTO
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Covered Entity Details
Entity Name
METHODIST HOSPITAL OF SACRAMENTO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050590
Entity Address
7500 HOSPITAL DRIVE
SACRAMENTO, CA 95823
Medicare Provider Number
050590
Participating Start Date
4/1/2005
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05036
4495 MACK RD
SACRAMENTO, CA 95823
Pharmacy Comments
Contract Details
Approval Date
10/2/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bonnie Helen Jenkins, CFO
(916) 453-4459
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/2/2013
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