340B Drug Pricing Program Database

Pharmacy Name

PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFO

Pharmacy Address

DBA PROVIDENCE SAINT JOSEPH MEDICAL CENT
501 SOUTH BUENA VISTA STREET 1ST FL
BURBANK, CA 91505-4809

Pharmacy Comments

Approval Date

1/21/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/24/2020
Agreement registered in error

Covered Entity Signing Official

Glenn Bales, Chief Financial Officer
(818) 847-3022

Contract Pharmacy Representative

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

Signed By Date

1/21/2020