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WALGREEN EASTERN CO INC
DSH390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390174
Entity Address
111 South 11th Street
Philadelphia, PA 19107
Medicare Provider Number
390174
Participating Start Date
4/1/2006
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO INC
Pharmacy Address
DBA: WALGREENS # 04115
4201 N BROAD ST
PHILADELPHIA, PA 19140
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/30/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Andrew Nathans, Vice president Finance, TJUH Inc.
(215) 955-6599
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2020
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