Contract Pharmacy Details

WALGREEN CO.
DSH500033 SAMARITAN HOSPITAL

Covered Entity Details

Entity Name

SAMARITAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500033

Entity Address

801 E WHEELER ROAD
MOSES LAKE, WA 98837

Medicare Provider Number

500033

Participating Start Date

1/1/2009

Last Recertification Date

8/20/2019

Entity Termination Date

7/1/2020

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #02647
200 E. BROADWAY AVE.
MOSES LAKE, WA 98837

Pharmacy Comments

Contract Details

Approval Date

1/12/2012

Contract Begin Date

1/12/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Thomas J. Legel, CFO
(509) 793-9710

Contract Pharmacy Representative

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

Signed By Date

12/29/2011

340B Drug Pricing Program Database