Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL

Covered Entity Details

Entity Name

THOMAS JEFFERSON UNIVERSITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH390174

Entity Address

111 South 11th Street
Philadelphia, PA 19107

Medicare Provider Number

390174

Participating Start Date

4/1/2006

Last Recertification Date

9/8/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS # 03791
2014-24 S BROAD ST
PHILADELPHIA, PA 19145

Pharmacy Comments

Contract Details

Approval Date

4/21/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/12/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

NEIL G. LUBARSKY, SR VP FOR FINANCE
(215) 955-9993

Contract Pharmacy Representative

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

Signed By Date

4/21/2016

340B Drug Pricing Program Database