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WALGREEN CO.
CAH051333-00 Ridgecrest Regional Hospital
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Covered Entity Details
Entity Name
Ridgecrest Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051333-00
Entity Address
1081 N. China Lake Blvd.
Ridgecrest, CA 93555
Medicare Provider Number
051333
Participating Start Date
10/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09030
101 W DRUMMOND AVE
RIDGECREST, CA 93555
Pharmacy Comments
Contract Details
Approval Date
10/9/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Suver, CEO
(760) 499-3902
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/9/2013
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