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WALGREEN EASTERN CO., INC.
DSH220066 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220066
Entity Address
271 CAREW STREET
SPRINGFIELD, MA 01104
Medicare Provider Number
220066
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19944
71 PALOMBA DR
ENFIELD, CT 06082-3801
Pharmacy Comments
Contract Details
Approval Date
4/1/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Roose, Chief Administrative Officer
(413) 748-9302
Contract Pharmacy Representative
Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116
Signed By Date
4/1/2025
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