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WALGREEN CO.
DSH050305 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
DSH050305
Entity Address
2450 ASHBY AVENUE
BERKELEY, CA 94705
Medicare Provider Number
050305
Participating Start Date
7/1/2006
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 15025
2190 SHATTUCK AVENUE
BERKELEY, CA 94704-1307
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/23/2023
Pharmacy closed
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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