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WALGREEN CO.
DSH450024 UNIVERSITY MEDICAL CENTER OF EL PASO
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER OF EL PASO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450024
Entity Address
4815 ALAMEDA AVE.
EL PASO, TX 79905
Medicare Provider Number
450024
Participating Start Date
12/1/1992
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21172
2701 N MESA ST STE 100A
EL PASO, TX 79902
Pharmacy Comments
Contract Details
Approval Date
10/16/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL NUNEZ, CFO
(915) 521-7626
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2019
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