Contract Pharmacy Details

WALGREEN CO.
DSH050454 UCSF-MEDICAL CENTER

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 # 15025
2190 SHATTUCK AVENUE
BERKELEY, CA 94704-1307

Pharmacy Comments

Contract Details

Approval Date

10/1/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/2/2020
Pharmacy closed

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

10/1/2015

340B Drug Pricing Program Database