Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH330024 THE MOUNT SINAI HOSPITAL

Covered Entity Details

Entity Name

THE MOUNT SINAI HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330024

Entity Address

ONE GUSTAVE L. LEVY PLACE
NEW YORK, NY 10029

Medicare Provider Number

330024

Participating Start Date

7/1/2004

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16512
3462 JEROME AVE.
BRONX, NY 10467

Pharmacy Comments

Contract Details

Approval Date

4/15/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/18/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

KENNETH DAVIS, CEO
(212) 659-8888

Contract Pharmacy Representative

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

Signed By Date

4/15/2016

340B Drug Pricing Program Database