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WALGREEN CO.
PED053300-00 VALLEY CHILDRENS HOSPITAL
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Covered Entity Details
Entity Name
VALLEY CHILDRENS HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED053300-00
Entity Address
9300 VALLEY CHILDRENS PLACE
MADERA, CA 93636
Medicare Provider Number
053300
Participating Start Date
7/1/2017
Last Recertification Date
11/10/2017
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03330
1640 R STREET
MERCED, CA 95340
Pharmacy Comments
Contract Details
Approval Date
6/12/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michele R. Waldron, Chief Financial Officer
(559) 353-7090
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/12/2017
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