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WALGREEN EASTERN CO., INC.
DSH330241 UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330241
Entity Address
750 East Adams Street
Syracuse, NY 13210
Medicare Provider Number
330241
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
RITE AID #03424
300 W MANLIUS ST
EAST SYRACUSE, NY 13057
Pharmacy Comments
Contract Details
Approval Date
10/9/2018
Contract Begin Date
10/9/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Robert John Corona, CEO
(315) 464-4223
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/9/2018
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