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WALGREEN EASTERN CO., INC.
DSH220066 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220066
Entity Address
271 CAREW STREET
SPRINGFIELD, MA 01104
Medicare Provider Number
220066
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS SPECIALTY PHARMACY #16537
619 CHESTNUT ST.
SPRINGFIELD, MA 01107
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/20/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Charles Flinn, COO
(413) 748-9008
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2017
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