Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH330006 ST. JOSEPHS MEDICAL CENTER

Covered Entity Details

Entity Name

ST. JOSEPHS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330006

Entity Address

127 South Broadway
YONKERS, NY 10701

Medicare Provider Number

330006

Participating Start Date

7/1/2022

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: COMMUNITY, A WALGREENS PHARMACY #16
3954 BROADWAY
NEW YORK, NY 10032

Pharmacy Comments

Contract Details

Approval Date

7/15/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/29/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

MICHAEL J SPICER, CEO
(914) 378-7485

Contract Pharmacy Representative

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

Signed By Date

7/15/2022

340B Drug Pricing Program Database