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WALGREEN CO
DSH050228 Zuckerberg San Francisco General
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Covered Entity Details
Entity Name
Zuckerberg San Francisco General
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050228
Entity Address
1001 Potrero Ave
San Francisco, CA 94110
Medicare Provider Number
050228
Participating Start Date
7/1/1994
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11385
1580 VALENCIA ST STE 101
SAN FRANCISCO, CA 94110
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/21/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Susan Ehrlich, CEO
(628) 206-8118
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2021
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