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WALGREEN EASTERN CO., INC.
DSH310029 Virtua Our Lady Of Lourdes Hospital
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Covered Entity Details
Entity Name
Virtua Our Lady Of Lourdes Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310029
Entity Address
1600 HADDON AVENUE
CAMDEN, NJ 08103
Medicare Provider Number
310029
Participating Start Date
7/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 06929
1819 ROUTE 70 WEST
CHERRY HILL, NJ 08002
Pharmacy Comments
Contract Details
Approval Date
1/20/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL HAMMOND, CFO
(856) 757-3809
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/20/2015
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