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WALGREEN CO
DSH050438 HUNTINGTON HOSPITAL
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Covered Entity Details
Entity Name
HUNTINGTON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050438
Entity Address
100 W. California Blvd
Pasadena, CA 91105
Medicare Provider Number
050438
Participating Start Date
7/1/2019
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11442
310 S LAKE AVE 1ST FL
PASADENA, CA 91101
Pharmacy Comments
Contract Details
Approval Date
5/18/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Mohr, Senior Vice President & Chief Financial Officer
(626) 397-5555
Contract Pharmacy Representative
Walgreens Health System
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
5/18/2020
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