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WALGREEN EASTERN CO., INC
DSH330033 CHENANGO MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CHENANGO MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330033
Entity Address
179 N. BROAD ST.
NORWICH, NY 13815
Medicare Provider Number
330033
Participating Start Date
10/1/2016
Last Recertification Date
9/5/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC
Pharmacy Address
WALGREENS #19952
82 NORTH BROAD ST
NORWICH, NY 13815
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Drake M Lamen, President & CEO / CMO
(607) 337-4113
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2022
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