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WALGREEN EASTERN CO., INC.
DSH220033BF BEVERLY HOSPITAL
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Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
Addison Gilbert Hospital / AGH OPERATING ROOM
Type
Disproportionate Share Hospital
340B ID
DSH220033BF
Entity Address
298 Washington Street, Gloucester, MA 01930
Third Floor
Gloucester, MA 01930
Medicare Provider Number
220033
Outpatient Facility Provider Number
Participating Start Date
10/1/2017
Last Recertification Date
9/15/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 02564
25 STOREY AVE STE 4
NEWBURYPORT, MA 01950
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
10/1/2023
Covered Entity Terminated
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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