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WALGREENS SPECIALTY PHARMACY, LLC
DSH050441 STANFORD HEALTH CARE
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Covered Entity Details
Entity Name
STANFORD HEALTH CARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050441
Entity Address
300 PASTEUR DRIVE
Stanford, CA 94305
Medicare Provider Number
050441
Participating Start Date
7/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR, STE 1
BEAVERTON, OR 97008
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Linda Hoff, CFO
(650) 497-0391
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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