Contract Pharmacy Details

WALGREEN CO.
DSH050058 GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER

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 # 06854
2222 COLORADO BLVD
LOS ANGELES, CA 90041

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

340B Drug Pricing Program Database