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WALGREEN EASTERN CO., INC.
DSH330056 THE BROOKLYN HOSPITAL CENTER
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Covered Entity Details
Entity Name
THE BROOKLYN HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330056
Entity Address
121 DEKALB AVE
BROOKLYN, NY 11201
Medicare Provider Number
330056
Participating Start Date
4/1/2005
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #12007
1404 ROCKAWAY PKWY.
BROOKLYN, NY 11236-2322
Pharmacy Comments
Contract Details
Approval Date
4/22/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/28/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Guarracino, Senior Vice President and CFO
(718) 250-6755
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/22/2014
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