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WALGREEN EASTERN CO., INC.
DSH070006 THE STAMFORD HOSPITAL
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Covered Entity Details
Entity Name
THE STAMFORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070006
Entity Address
One Hospital Plaza
STAMFORD, CT 06902
Medicare Provider Number
070006
Participating Start Date
7/1/2016
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 05723
960 NORTH AVE
BRIDGEPORT, CT 06606-5741
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kevin Gage, Chief Financial Officer
(203) 276-7463
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2018
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