340B Drug Pricing Program Database
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WALGREEN CO.
DSH050191 ST. MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. MARY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050191
Entity Address
1050 LINDEN AVENUE
LONG BEACH, CA 90813-3393
Medicare Provider Number
050191
Participating Start Date
1/1/2017
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07870
600 LONG BEACH BLVD
LONG BEACH, CA 90802
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/25/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Leon Choiniere, Vice President/Chief Financial Officer
(562) 491-9191
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2020
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