340B Drug Pricing Program Database
WALGREEN CO.
DSH100034 MOUNT SINAI MEDICAL CENTER - information as of 5/2/2025 12:39:35 AM
Covered Entity Details
Entity Name
MOUNT SINAI MEDICAL CENTER
Subdivision Name
MOUNT SINAI MEDICAL CENTER OF FLORIDA INC.
Type
Disproportionate Share Hospital
340B ID
DSH100034
Entity Address
4300 Alton Road
MIAMI BEACH, FL 33140
Medicare Provider Number
100034
Participating Start Date
4/1/2007
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03678
1501 NE 163RD STREET
NORTH MIAMI BEACH, FL 33162
Pharmacy Comments
Contract Details
Approval Date
3/6/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/19/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Alex Mendez, SR VP & CFO
(305) 674-2089
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/29/2013
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