Contract Pharmacy Details

WALGREEN CO.
DSH500041 PEACEHEALTH ST. JOHN MEDICAL CENTER

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 #10056
175 S. COLUMBIA RIVER HWY.
SAINT HELENS, OR 97051

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

340B Drug Pricing Program Database