Contract Pharmacy Details

WALGREEN CO.
DSH450686 UNIVERSITY MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450686

Entity Address

602 INDIANA AVE
LUBBOCK, TX 79415

Medicare Provider Number

450686

Participating Start Date

12/1/1992

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05996
2417 82ND ST
LUBBOCK, TX 79423

Pharmacy Comments

Contract Details

Approval Date

4/15/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/23/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

DAVID ALLISON, CEO
(806) 775-8517

Contract Pharmacy Representative

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

Signed By Date

4/15/2014

340B Drug Pricing Program Database