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WALGREEN EASTERN CO., INC.
DSH330203 CROUSE HOSPITAL
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Covered Entity Details
Entity Name
CROUSE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330203
Entity Address
736 IRVING AVE
SYRACUSE, NY 13210
Medicare Provider Number
330203
Participating Start Date
10/1/2023
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS 17848
1365 W GENESEE ST
CHITTENANGO, NY 13037
Pharmacy Comments
Contract Details
Approval Date
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Kevin Randall, Chief Financial Officer
(315) 470-7589
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2024
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