Contract Pharmacy Details

WALGREEN CO.
SCH050279-00 Hi-Desert Memorial Health Care District

Covered Entity Details

Entity Name

Hi-Desert Memorial Health Care District

Subdivision Name

Hi-Desert Medical Center

Type

Sole Community Hospital

340B ID

SCH050279-00

Entity Address

6601 White Feather Road
Joshua Tree, CA 92252-6607

Medicare Provider Number

050279

Participating Start Date

4/1/2013

Last Recertification Date

9/10/2015

Entity Termination Date

10/1/2015

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06399
58133 29 PALMS HWY
YUCCA VALLEY, CA 92284

Pharmacy Comments

Contract Details

Approval Date

4/14/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2015

Contacts

Covered Entity Signing Official

Robert C. Tyk, Chief Finance Officer
(760) 366-6421

Contract Pharmacy Representative

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

Signed By Date

4/14/2014

340B Drug Pricing Program Database