Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
DSH330078 SISTERS OF CHARITY HOSPITAL

Covered Entity Details

Entity Name

SISTERS OF CHARITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330078

Entity Address

2157 MAIN STREET
BUFFALO, NY 14214

Medicare Provider Number

330078

Participating Start Date

1/1/2014

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREENS SPECIALTY PHARMACY, LLC

Pharmacy Address

ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR, STE 1
BEAVERTON, OR 97008

Pharmacy Comments

Contract Details

Approval Date

1/12/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Michael Osborne, Vice President, Finance
(716) 828-2011

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/12/2016

340B Drug Pricing Program Database