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WALGREEN EASTERN CO., INC.
DSH330350 UNIVERSITY HOSPITAL OF BROOKLYN
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL OF BROOKLYN
Subdivision Name
SUNY DOWNSTATE MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330350
Entity Address
445 LENOX ROAD
Attn: Pharmacy Box 36
BROOKLYN, NY 11203
Medicare Provider Number
330350
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS
5001 CHURCH AVE.
BROOKLYN, NY 11203-1320
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Bayard Miller, Chief Financial OIfficer
(718) 270-4901
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2020
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