Contract Pharmacy Details

WALGREEN CO.
DSH050152 UCSF HEALTH - ST. FRANCIS HOSPITAL

Covered Entity Details

Entity Name

UCSF HEALTH - ST. FRANCIS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050152

Entity Address

900 HYDE STREET
SAN FRANCISCO, CA 94109

Medicare Provider Number

050152

Participating Start Date

10/1/2004

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06291
116 NEW MONTGOMERY ST
SAN FRANCISCO, CA 94105

Pharmacy Comments

Contract Details

Approval Date

1/14/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/13/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Kecia Kelly, COO/CNO
(415) 353-6173

Contract Pharmacy Representative

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

Signed By Date

1/14/2020

340B Drug Pricing Program Database