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WALGREEN CO.
RRC500072-00 OLYMPIC MEDICAL CENTER
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Covered Entity Details
Entity Name
OLYMPIC MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC500072-00
Entity Address
939 CAROLINE STREET
PORT ANGELES, WA 98362
Medicare Provider Number
500072
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11215
932 E. FRONT ST.
PORT ANGELES, WA 98362
Pharmacy Comments
Contract Details
Approval Date
1/4/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Darryl Wolfe, Chief Executive Officer
(360) 417-7705
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/4/2018
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