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WALGREEN CO.
CAN100079-00 UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN100079-00
Entity Address
1475 NW 12th Avenue
2080A
Miami, FL 33136
Medicare Provider Number
100079
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #16542
1475 NW 12TH AVE STE 2307B
MIAMI, FL 33136
Pharmacy Comments
Contract Details
Approval Date
4/28/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RICHARD BALLARD, HOSPITAL ADMINISTRATOR/CEO
(305) 243-4382
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/28/2017
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