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WALGREEN EASTERN CO., INC.
RRC330103-00 Olean General Hospital
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Covered Entity Details
Entity Name
Olean General Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330103-00
Entity Address
515 Main Street
Olean, NY 14760
Medicare Provider Number
330103
Participating Start Date
4/1/2014
Last Recertification Date
8/23/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #17344
4175 STATE ROUTE 417
WELLSVILLE, NY 14895
Pharmacy Comments
Contract Details
Approval Date
7/19/2018
Contract Begin Date
7/30/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard G. Braun Jr., SVP Finance and CFO
(716) 375-6190
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/19/2018
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