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WALGREEN CO.
DSH050454 UCSF-MEDICAL CENTER
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Covered Entity Details
Entity Name
UCSF-MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050454
Entity Address
505 PARNASSUS AVE.
SAN FRANCISCO, CA 94143
Medicare Provider Number
050454
Participating Start Date
7/1/1993
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01109
5260 DIAMOND HEIGHTS BLVD
SAN FRANCISCO, CA 94131
Pharmacy Comments
Contract Details
Approval Date
5/11/2012
Contract Begin Date
5/23/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/23/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARK LARET, CEO
(415) 353-2733
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
5/23/2012
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