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WALGREEN EASTERN CO., INC.
DSH330055 NEWYORK-PRESBYTERIAN / QUEENS
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Covered Entity Details
Entity Name
NEWYORK-PRESBYTERIAN / QUEENS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330055
Entity Address
56-45 MAIN STREET
FLUSHING, NY 11355
Medicare Provider Number
330055
Participating Start Date
4/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 04564
159-34 JAMAICA AVE
JAMAICA, NY 11432-6001
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
11/7/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Kevin Ward, Senior VP FOR FINANCE
(718) 670-1476
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2018
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