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WALGREEN EASTERN CO., INC.
DSH330241 UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330241
Entity Address
750 East Adams Street
Syracuse, NY 13210
Medicare Provider Number
330241
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS
100 E MAIN ST
ENDICOTT, NY 13760
Pharmacy Comments
Contract Details
Approval Date
7/18/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart M. Wright, Chief Financial Officer
(315) 464-5179
Contract Pharmacy Representative
Walgreen Co.
Brittany Daurio, Analyst, 340B Client Relationship
(847) 315-6167
Signed By Date
7/18/2022
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