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WALGREEN CO.
DSH050058 GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER
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Covered Entity Details
Entity Name
GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050058
Entity Address
1420 SOUTH CENTRAL AVE
GLENDALE, CA 91204
Medicare Provider Number
050058
Participating Start Date
1/1/2005
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06250
1028 S SAN FERNANDO BLVD
BURBANK, CA 91502
Pharmacy Comments
Contract Details
Approval Date
10/1/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Allen, CFO
(818) 502-2204
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/1/2013
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