Contract Pharmacy Details

WALGREEN CO.
DSH290007 UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA

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 CO.

Pharmacy Address

DBA: WALGREENS #12646
329 N. SANDHILL BLVD
MESQUITE, NV 89027-4729

Pharmacy Comments

Contract Details

Approval Date

4/25/2013

Contract Begin Date

7/1/2013

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

Stephanie Merrill, CFO
(702) 383-7835

Contract Pharmacy Representative

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

Signed By Date

4/25/2013

340B Drug Pricing Program Database