Contract Pharmacy Details

WALGREEN CO.
DSH100034 MOUNT SINAI MEDICAL CENTER

Covered Entity Details

Entity Name

MOUNT SINAI MEDICAL CENTER

Subdivision Name

MOUNT SINAI MEDICAL CENTER OF FLORIDA INC.

Type

Disproportionate Share Hospital

340B ID

DSH100034

Entity Address

4300 Alton Road
MIAMI BEACH, FL 33140

Medicare Provider Number

100034

Participating Start Date

4/1/2007

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03211
9675 NW 41ST STREET
DORAL, FL 33178-2974

Pharmacy Comments

Contract Details

Approval Date

3/6/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/31/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Alex Mendez, SR VP & CFO
(305) 674-2089

Contract Pharmacy Representative

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

Signed By Date

1/29/2013

340B Drug Pricing Program Database