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WALGREEN EASTERN CO., INC.
DSH330241 UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330241
Entity Address
750 East Adams Street
Syracuse, NY 13210
Medicare Provider Number
330241
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #17276
3588 STATE ROUTE 31
BALDWINSVILLE, NY 13027-8232
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Stuart M. Wright, Chief Financial Officer
(315) 464-5179
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/11/2022
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