Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH330055 NEWYORK-PRESBYTERIAN / QUEENS

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 # 05051
21914 MERRICK BLVD
LAURELTON, NY 11413

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

12/15/2021
Business decision by covered entity and/or pharmacy

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

340B Drug Pricing Program Database