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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
WALGREENS #19964
77-105 BLOOMFIELD AVE
BLOOMFIELD, NJ 07003-5985
Pharmacy Comments
Contract Details
Approval Date
7/8/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
YASMIR BISAL, Vice President Finance
(973) 450-2164
Contract Pharmacy Representative
Walgreens
Elizabeth Bauer, Strategic Account Manager-East division
(407) 451-3020
Signed By Date
7/8/2022
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