Contract Pharmacy Details

WALGREEN CO.
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

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #21141
217 ALMA ST STE 200
PALO ALTO, CA 94301

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

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/11/2018

340B Drug Pricing Program Database