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 #11385
1580 VALENCIA ST STE 101
SAN FRANCISCO, CA 94110

Pharmacy Comments

Contract Details

Approval Date

4/3/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/17/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Sheila Antrum, SVP-AdultSvcs/President-MedCtr
(415) 353-2717

Contract Pharmacy Representative

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

Signed By Date

4/3/2018

340B Drug Pricing Program Database