Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
DSH050222 SHARP CHULA VISTA MEDICAL CENTER

Covered Entity Details

Entity Name

SHARP CHULA VISTA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050222

Entity Address

751 MEDICAL CENTER COURT
CHULA VISTA, CA 91911

Medicare Provider Number

050222

Participating Start Date

7/1/2004

Last Recertification Date

8/29/2024

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

10/17/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

RICK KING, CFO
(619) 502-3664

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/17/2016

340B Drug Pricing Program Database