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WALGREEN EASTERN CO., INC.
DSH330153 Ellis Hospital
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Covered Entity Details
Entity Name
Ellis Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330153
Entity Address
1101 Nott Street
Schenectady, NY 12308
Medicare Provider Number
330153
Participating Start Date
7/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21158
33 NEW SCOTLAND AVE STE 106
ALBANY, NY 12208
Pharmacy Comments
Contract Details
Approval Date
10/18/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marc Mesick, CFO & VP of Finance
(518) 243-4144
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/18/2024
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