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WALGREEN CO.
DSH100034 MOUNT SINAI MEDICAL CENTER
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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
WALGREENS #16542
1475 NW 12TH AVE STE 2307B
MIAMI, FL 33136
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2019
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