Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH220086T BETH ISRAEL DEACONESS MEDICAL CENTER

Covered Entity Details

Entity Name

BETH ISRAEL DEACONESS MEDICAL CENTER

Subdivision Name

MEDICAL CARE CENTER OF LEXINGTON - GI OFFICE

Type

Disproportionate Share Hospital

340B ID

DSH220086T

Entity Address

482 BEDFORD STREET
LEXINGTON, MA 02420

Medicare Provider Number

220086

Outpatient Facility Provider Number

Participating Start Date

1/1/2019

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS # 03112
1425 MASSACHUSETTS AVE.
ARLINGTON, MA 02476

Pharmacy Comments

Contract Details

Approval Date

4/21/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Matthew Larkin, Chief Operating Officer
(617) 677-7144

Contract Pharmacy Representative

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

Signed By Date

4/21/2023

340B Drug Pricing Program Database