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WALGREEN EASTERN CO., INC.
DSH220033Q BEVERLY HOSPITAL
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Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
LAHEY OUTPATIENT CENTERS DANVERS / DAN BREAST HEALTH
Type
Disproportionate Share Hospital
340B ID
DSH220033Q
Entity Address
480 Maple Street
Suite 106
Danvers, MA 01923
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 # 04595
59 BOSTON 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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