340B Drug Pricing Program Database
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WALGREEN CO.
DSH500041 PEACEHEALTH ST. JOHN MEDICAL CENTER
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Covered Entity Details
Entity Name
PEACEHEALTH ST. JOHN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500041
Entity Address
1615 DELAWARE ST
LONGVIEW, WA 98632
Medicare Provider Number
500041
Participating Start Date
7/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09812
2939 OCEAN BEACH HWY
LONGVIEW, WA 98632-3513
Pharmacy Comments
Contract Details
Approval Date
1/25/2012
Contract Begin Date
1/25/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Haywood, Regional Chief Financial Officer
(360) 514-3103
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/25/2012
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