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WALGREEN CO.
DSH050149 CALIFORNIA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CALIFORNIA HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050149
Entity Address
1401 SOUTH GRAND AVENUE
LOS ANGELES, CA 90015
Medicare Provider Number
050149
Participating Start Date
1/1/2005
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12913
1500 E GAGE AVE
LOS ANGELES, CA 90001
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
10/12/2017
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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