Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH390115 Jefferson Health Northeast

Covered Entity Details

Entity Name

Jefferson Health Northeast

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH390115

Entity Address

10800 Knights Rd.
PHILADELPHIA, PA 19114

Medicare Provider Number

390115

Participating Start Date

10/1/2017

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS # 06367
1809 E ALLEGHENY AVE
PHILADELPHIA, PA 19134

Pharmacy Comments

Contract Details

Approval Date

7/14/2022

Contract Begin Date

7/19/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/2/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

CARRIE FREY, Director of Finance
(215) 612-4313

Contract Pharmacy Representative

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

Signed By Date

7/14/2022

340B Drug Pricing Program Database