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WALGREEN CO.
DSH050067 OAK VALLEY DISTRICT HOSPITAL
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Covered Entity Details
Entity Name
OAK VALLEY DISTRICT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050067
Entity Address
350 SOUTH OAK STREET
OAKDALE, CA 95361
Medicare Provider Number
050067
Participating Start Date
4/1/2016
Last Recertification Date
8/21/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06355
4201 DALE ROAD
MODESTO, CA 95356
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
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ann Croskrey, CFO
(209) 848-4104
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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