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WALGREEN EASTERN CO., INC.
DSH220011 CAMBRIDGE PUBLIC HEALTH COMMISSION
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Covered Entity Details
Entity Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220011
Entity Address
1493 Cambridge Street
CAMBRIDGE, MA 02139
Medicare Provider Number
220011
Participating Start Date
7/1/1998
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #15001
980 AMERICAN LEGION HWY
ROSLINDALE, MA 02131-4701
Pharmacy Comments
02/25/2013 corrected address error (was store #05756); 11/05/2012 store relocation (was Walgreens #1849 972 AMERICAN LEGION HWY ROSLINDALE MA 02131)
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew M Fuqua, Senior Vice President and General Counsel
(617) 665-1000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2021
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