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WALGREEN EASTERN CO., INC.
DSH220033 BEVERLY HOSPITAL
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Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220033
Entity Address
85 HERRICK STREET
BEVERLY, MA 01915
Medicare Provider Number
220033
Participating Start Date
4/1/2013
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #17221
127 EASTERN AVE STE 135
GLOUCESTER, MA 01930
Pharmacy Comments
Contract Details
Approval Date
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Connie Woodworth, Vice President Finance
(978) 922-3000 Ext: 2587
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/3/2019
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