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WALGREEN EASTERN CO., INC.
DSH330013 ALBANY MEDICAL CENTER HOSPITAL
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Covered Entity Details
Entity Name
ALBANY MEDICAL CENTER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330013
Entity Address
43 NEW SCOTLAND AVENUE
ALBANY, NY 12208
Medicare Provider Number
330013
Participating Start Date
4/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
RITE AID #10692
911 CENTRAL AVE
STE 10
ALBANY, NY 12206-1304
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/12/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
FERDINAND J. VENDITTI, EXECUTIVE VP FOR SYSTEM CARE DELIVERY
(518) 262-5376
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/11/2019
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