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WALGREEN CO
DSH050761 TARZANA MEDICAL CENTER LLC DBA PROVIDENCE CEDARS SINAI TARZANA MEDICAL CENTER
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Covered Entity Details
Entity Name
TARZANA MEDICAL CENTER LLC DBA PROVIDENCE CEDARS SINAI TARZANA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050761
Entity Address
18321 CLARK STREET
TARZANA, CA 91356
Medicare Provider Number
050761
Participating Start Date
1/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #01813
18568 VENTURA BLVD
TARZANA, CA 91356
Pharmacy Comments
Contract Details
Approval Date
7/5/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jessica Marie Trimble, Chief Financial Officer
(818) 401-4195
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/5/2023
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