340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
RRC460006-00 LDS HOSPITAL
Print
Covered Entity Details
Entity Name
LDS HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC460006-00
Entity Address
8TH AVENUE AND C STREET.
SALT LAKE CITY, UT 84143
Medicare Provider Number
460006
Participating Start Date
1/3/2022
Last Recertification Date
8/25/2022
Entity Termination Date
5/15/2023
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05875
7794 S REDWOOD RD
WEST JORDAN, UT 84084
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
4/14/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/15/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mike DeMotte, Finance Director
(801) 408-2087
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session