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WALGREENS SPECIALTY PHARMACY, LLC
DSH330385 NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330385
Entity Address
3424 KOSSUTH AVE.
BRONX, NY 10467
Medicare Provider Number
330385
Participating Start Date
12/1/1992
Last Recertification Date
8/16/2021
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2014
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