Contract Pharmacy Details

WALGREEN CO.
DSH460009 University of Utah

Covered Entity Details

Entity Name

University of Utah

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH460009

Entity Address

50 North Medical Drive
Salt Lake City, UT 84132

Medicare Provider Number

460009

Participating Start Date

7/1/1996

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15623
5586 WEST 6200 SOUTH
KEARNS, UT 84118

Pharmacy Comments

Contract Details

Approval Date

7/17/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Charlton Gordon Park, Chief Financial Officer
(801) 585-1325

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/17/2023

340B Drug Pricing Program Database