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WALGREENS SPECIALTY PHARMACY, LLC
PED053309-00 Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital Long Beach
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Covered Entity Details
Entity Name
Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital Long Beach
Subdivision Name
Type
Children's Hospital
340B ID
PED053309-00
Entity Address
2801 Atlantic Avenue 1st FL B1A3020
Long Beach, CA 90806-1428
Medicare Provider Number
053309
Participating Start Date
4/1/2013
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
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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