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WALGREEN EASTERN CO., INC.
DSH310074 JERSEY CITY MEDICAL CENTER
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Covered Entity Details
Entity Name
JERSEY CITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310074
Entity Address
355 GRAND STREET
JERSEY CITY, NJ 07302
Medicare Provider Number
310074
Participating Start Date
4/1/1997
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19708
395 DANFORTH AVE
JERSEY CITY, NJ 07305-1975
Pharmacy Comments
Contract Details
Approval Date
4/2/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Alexander Filipiak, Site Finance Officer
(973) 926-8208
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/2/2024
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