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WALGREEN EASTERN CO., INC.
DSH220033AR BEVERLY HOSPITAL
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Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
ADDISON GILBERT HOSPITAL / AGH CT SCAN
Type
Disproportionate Share Hospital
340B ID
DSH220033AR
Entity Address
298 Washington St
Gloucester, MA 01930
Medicare Provider Number
220033
Outpatient Facility Provider Number
Participating Start Date
10/1/2017
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 02517
201 MAIN STREET
GLOUCESTER, MA 01930
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tom Sands, President
(978) 816-2580
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/18/2023
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