Contract Pharmacy Details

ESI MAIL PHARMACY SERVICE
DSH050262 RONALD REAGAN UCLA MEDICAL CENTER

Covered Entity Details

Entity Name

RONALD REAGAN UCLA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050262

Entity Address

757 WESTWOOD PLAZA
LOS ANGELES, CA 90095

Medicare Provider Number

050262

Participating Start Date

1/1/1998

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

ESI MAIL PHARMACY SERVICE

Pharmacy Address

DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112

Pharmacy Comments

Contract Details

Approval Date

7/11/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Paul Staton, CFO
(310) 267-9308

Contract Pharmacy Representative

Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500

Signed By Date

7/11/2018

340B Drug Pricing Program Database