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WALGREEN EASTERN CO., INC.
DSH220033BA BEVERLY HOSPITAL
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Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
ADDISON GILBERT HOSPITAL / AGH GERIATRICS
Type
Disproportionate Share Hospital
340B ID
DSH220033BA
Entity Address
298 Washington Street
Fourth Floor
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 # 02063
29 NEW DERBY STREET
SALEM, MA 01970
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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