Contract Pharmacy Details

WALGREEN CO.
DSH050225 Adventist Health Feather River

Covered Entity Details

Entity Name

Adventist Health Feather River

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050225

Entity Address

5974 PENTZ ROAD
PARADISE, CA 95969

Medicare Provider Number

050225

Participating Start Date

10/1/2010

Last Recertification Date

8/30/2018

Entity Termination Date

7/1/2019

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04243
980 E CYPRESS AVE
REDDING, CA 96002

Pharmacy Comments

Contract Details

Approval Date

7/29/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

DANIEL K. GORDON, VP FINANCE/CFO
(530) 876-7200

Contract Pharmacy Representative

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

Signed By Date

7/29/2014

340B Drug Pricing Program Database