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WALGREEN ARIZONA DRUG CO.
DSH290007 UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH290007
Entity Address
1800 W Charleston Blvd.
LAS VEGAS, NV 89102
Medicare Provider Number
290007
Participating Start Date
7/1/1994
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 03913
2360 HIGHWAY 95
BULLHEAD CITY, AZ 86442
Pharmacy Comments
Contract Details
Approval Date
2/4/2011
Contract Begin Date
3/1/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/17/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
1/25/2011
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