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WALGREEN EASTERN CO., INC.
DSH310039 RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310039
Entity Address
530 NEW BRUNSWICK AVENUE
PERTH AMBOY, NJ 08861
Medicare Provider Number
310039
Participating Start Date
4/1/2013
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16512
3462 JEROME AVE.
BRONX, NY 10467
Pharmacy Comments
Contract Details
Approval Date
10/1/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia Carroll, President
(732) 324-5000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/1/2024
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