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WALGREEN CO.
DSH450024 UNIVERSITY MEDICAL CENTER OF EL PASO
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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 #13125
12201 MONTWOOD DR.
EL PASO, TX 79938
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
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