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WALGREEN EASTERN CO., INC.
DSH310014 THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310014
Entity Address
ONE COOPER PLAZA
CAMDEN, NJ 08103
Medicare Provider Number
310014
Participating Start Date
1/1/2005
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #10156
20 W. KINGS HWY.
MOUNT EPHRAIM, NJ 08059-1303
Pharmacy Comments
Contract Details
Approval Date
7/27/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/26/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Douglas E. Shirley, Senior Executive VP and CFO
(856) 342-2443
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/27/2017
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