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WALGREEN EASTERN CO INC
DSH390195 LANKENAU MEDICAL CENTER
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Covered Entity Details
Entity Name
LANKENAU MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390195
Entity Address
100 LANCASTER AVE.
WYNNEWOOD, PA 19096
Medicare Provider Number
390195
Participating Start Date
4/1/2023
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO INC
Pharmacy Address
DBA: WALGREENS # 04115
4201 N BROAD ST
PHILADELPHIA, PA 19140
Pharmacy Comments
Contract Details
Approval Date
2/2/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/30/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Yonathan M Kebede, Vice President, Operations
(614) 323-9829
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2023
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