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WALGREEN CO.
DSH050471 PIH HEALTH GOOD SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
PIH HEALTH GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050471
Entity Address
1225 Wilshire Blvd
LOS ANGELES, CA 90017-2395
Medicare Provider Number
050471
Participating Start Date
7/1/2008
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02156
2551 WEST MAIN STREET
ALHAMBRA, CA 91801
Pharmacy Comments
Contract Details
Approval Date
1/10/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES R. WEST, PRESIDENT and CEO
(562) 698-0811 Ext: 12413
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/10/2022
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