Contract Pharmacy Details

WALGREEN CO.
DSH450024 UNIVERSITY MEDICAL CENTER OF EL PASO

Covered Entity Details

Entity Name

UNIVERSITY MEDICAL CENTER OF EL PASO

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450024

Entity Address

4815 ALAMEDA AVE.
EL PASO, TX 79905

Medicare Provider Number

450024

Participating Start Date

12/1/1992

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11518
14300 HORIZON BLVD.
HORIZON CITY, TX 79928

Pharmacy Comments

Contract Details

Approval Date

1/15/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MICHAEL NUNEZ, CFO
(915) 521-7626

Contract Pharmacy Representative

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

Signed By Date

1/15/2015

340B Drug Pricing Program Database