340B Drug Pricing Program Database
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WALGREEN EASTERN CO., INC.
DSH330180 SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330180
Entity Address
2215 BURDETT AVE
TROY, NY 12180
Medicare Provider Number
330180
Participating Start Date
1/1/2019
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS
41 HOLLAND AVE.
ALBANY, NY 12208
Pharmacy Comments
Contract Details
Approval Date
4/21/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori Santos, CFO
(518) 525-5537
Contract Pharmacy Representative
Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116
Signed By Date
4/21/2025
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