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WALGREEN CO.
CAH051318-00 St Joseph Health Northern California LLC- DBA Redwood Memorial Hospital
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Covered Entity Details
Entity Name
St Joseph Health Northern California LLC- DBA Redwood Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051318-00
Entity Address
3300 Renner Drive
Fortuna, CA 95540
Medicare Provider Number
051318
Participating Start Date
4/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09703
1065 S FORTUNA BLVD
FORTUNA, CA 95540
Pharmacy Comments
Contract Details
Approval Date
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mich Riccioni, CFO
(707) 445-8121 Ext: 7491
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2015
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