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WALGREEN EASTERN CO., INC.
DSH220086DL BETH ISRAEL DEACONESS MEDICAL CENTER
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Covered Entity Details
Entity Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
BIDMC INFUSION SERVICES AT LAHEY PE - BIDMC Infusion Services at LHMC-Peabody
Type
Disproportionate Share Hospital
340B ID
DSH220086DL
Entity Address
1 ESSEX CENTER DR
PEABODY, MA 01960-2901
Medicare Provider Number
220086
Outpatient Facility Provider Number
Participating Start Date
10/1/2022
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #15001
980 AMERICAN LEGION HWY
ROSLINDALE, MA 02131-4701
Pharmacy Comments
02/25/2013 corrected address error (was store #05756); 11/05/2012 store relocation (was Walgreens #1849 972 AMERICAN LEGION HWY ROSLINDALE MA 02131)
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
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