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WALGREEN CO.
CAH051301-00 Adventist Health Medical Center Tehachapi
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Covered Entity Details
Entity Name
Adventist Health Medical Center Tehachapi
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051301-00
Entity Address
1100 Magellan DR
Tehachapi, CA 93561
Medicare Provider Number
051301
Participating Start Date
10/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07555
1101 W TEHACHAPI BLVD
TEHACHAPI, CA 93561
Pharmacy Comments
Contract Details
Approval Date
4/10/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
EVAN RAYNER, CHIEF EXECUTIVE OFFICER
(661) 823-3001 Ext: 223
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2014
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