Contract Pharmacy Details

WALGREEN CO.
DSH050254 MARSHALL HOSPITAL

Covered Entity Details

Entity Name

MARSHALL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050254

Entity Address

1100 MARSHALL WAY
PLACERVILLE, CA 95667

Medicare Provider Number

050254

Participating Start Date

1/1/2016

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #10599
4014 PLAZA GOLDORADO CIR.
CAMERON PARK, CA 95682

Pharmacy Comments

Contract Details

Approval Date

1/12/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/5/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

James Whipple, Chief Executive Officer
(530) 626-2601

Contract Pharmacy Representative

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

Signed By Date

1/12/2016

340B Drug Pricing Program Database