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WALGREEN EASTERN CO., INC.
DSH310019 St. Joseph’s University Medical Center
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Covered Entity Details
Entity Name
St. Joseph’s University Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310019
Entity Address
703 MAIN STREET
PATERSON, NJ 07503
Medicare Provider Number
310019
Participating Start Date
10/1/2002
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #13083
447 BELMONT AVE.
HALEDON, NJ 07508-1368
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dustin Riccio, President
(973) 754-2010
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2024
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