Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH330128 ELMHURST HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

ELMHURST HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330128

Entity Address

79-01 BROADWAY
ELMHURST, NY 11373

Medicare Provider Number

330128

Participating Start Date

12/1/1992

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS # 01180
3355 CRESCENT ST # 67
LONG ISLAND CITY, NY 11106

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

1/11/2024
Business decision by covered entity and/or pharmacy

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

340B Drug Pricing Program Database