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WALGREEN EASTERN CO., INC.
DSH310074 JERSEY CITY MEDICAL CENTER
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Covered Entity Details
Entity Name
JERSEY CITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310074
Entity Address
355 GRAND STREET
JERSEY CITY, NJ 07302
Medicare Provider Number
310074
Participating Start Date
4/1/1997
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 06162
508 MARTIN LUTHER KING
EAST ORANGE, NJ 07018-2207
Pharmacy Comments
06/11/2012 changed address (was 508 Martin Luther King)
Contract Details
Approval Date
1/10/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/2/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOSEPH F. SCOTT, PRESIDENT & CEO
(201) 521-5925
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/10/2014
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