340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
DSH050078 PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO
Print
Covered Entity Details
Entity Name
PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050078
Entity Address
1300 W 7TH STREET
SAN PEDRO, CA 90732
Medicare Provider Number
050078
Participating Start Date
7/1/2005
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05650
2627 PACIFIC AVENUE
LONG BEACH, CA 90806-2610
Pharmacy Comments
Contract Details
Approval Date
12/17/2019
Contract Begin Date
12/17/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/20/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ted Wang, CFO
(310) 303-6114
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
12/17/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session