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WALGREEN EASTERN CO., INC.
DSH330065 NIAGARA FALLS MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NIAGARA FALLS MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330065
Entity Address
621-10TH STREET
NIAGARA FALLS, NY 14302
Medicare Provider Number
330065
Participating Start Date
10/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #12117
1066 PAYNE AVE.
NORTH TONAWANDA, NY 14120-2720
Pharmacy Comments
Contract Details
Approval Date
10/2/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Raj Mehta, CFO/Vice President of Finance
(716) 278-4399
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/2/2013
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