Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH330014A JAMAICA HOSPITAL MEDICAL CENTER

Covered Entity Details

Entity Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER

Type

Disproportionate Share Hospital

340B ID

DSH330014A

Entity Address

133-03 JAMAICA AVENUE
RICHMOND HILLS, NY 11418

Medicare Provider Number

330014

Outpatient Facility Provider Number

Participating Start Date

1/1/2007

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS # 05051
21914 MERRICK BLVD
LAURELTON, NY 11413

Pharmacy Comments

Contract Details

Approval Date

7/7/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/27/2019
Agreement registered in error

Contacts

Covered Entity Signing Official

MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291

Contract Pharmacy Representative

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

Signed By Date

7/7/2017

340B Drug Pricing Program Database