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WALGREEN EASTERN CO., INC.
DSH330059 MONTEFIORE MEDICAL CENTER
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Covered Entity Details
Entity Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330059
Entity Address
111 EAST 210TH STREET
BRONX, NY 10467
Medicare Provider Number
330059
Participating Start Date
4/1/2005
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS
1612 WESTCHESTER AVE
BRONX, NY 10472
Pharmacy Comments
Contract Details
Approval Date
7/16/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
David Menashy, Vice President of Finance
(917) 280-2722
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2020
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