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WALGREEN CO
DSH050043 Sutter Bay Hospitals, dba Alta Bates Summit Medical Center
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Covered Entity Details
Entity Name
Sutter Bay Hospitals, dba Alta Bates Summit Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050043
Entity Address
350 HAWTHORNE AVENUE
OAKLAND, CA 94609
Medicare Provider Number
050043
Participating Start Date
7/1/2006
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10526
3250 LAKESHORE AVE STE B
OAKLAND, CA 94610-2720
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patti Pilgrim, CFO
(510) 869-8620
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2018
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