Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH330238 NICHOLAS H. NOYES MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

NICHOLAS H. NOYES MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330238

Entity Address

111 CLARA BARTON STREET
DANSVILLE, NY 14437

Medicare Provider Number

330238

Participating Start Date

10/1/2017

Last Recertification Date

8/15/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #11716
321 W. WASHINGTON ST.
BATH, NY 14810-1017

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

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jay Maslyn, CFO
(585) 335-4306

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/11/2019

340B Drug Pricing Program Database