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WALGREEN EASTERN CO., INC.
DSH310019 St. Joseph’s University Medical Center
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Covered Entity Details
Entity Name
St. Joseph’s University Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310019
Entity Address
703 MAIN STREET
PATERSON, NJ 07503
Medicare Provider Number
310019
Participating Start Date
10/1/2002
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16566
368 BROADWAY
PATERSON, NJ 07501
Pharmacy Comments
Contract Details
Approval Date
10/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Slavin, President and CEO
(973) 754-2002 Ext: 9737542010
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2018
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