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WALGREEN CO.
DSH050485 Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
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Covered Entity Details
Entity Name
Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050485
Entity Address
2801 ATLANTIC AVENUE
LONG BEACH, CA 90806
Medicare Provider Number
050485
Participating Start Date
7/1/2004
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07870
600 LONG BEACH BLVD
LONG BEACH, CA 90802
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/13/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Patti Pilgrim, Chief Financial Officer
(562) 933-1905
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/9/2023
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