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WALGREEN EASTERN CO., INC.
DSH310009 CLARA MAASS MEDICAL CENTER
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Covered Entity Details
Entity Name
CLARA MAASS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310009
Entity Address
ONE CLARA MAASS DRIVE
BELLEVILLE, NJ 07109-3550
Medicare Provider Number
310009
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 03379
61 FERRY ST
NEWARK, NJ 07105
Pharmacy Comments
Contract Details
Approval Date
4/11/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Yasmir Bisal, VP Finance
(973) 450-2164
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2013
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