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WALGREEN EASTERN CO., INC.
DSH330101 NEW YORK-PRESBYTERIAN HOSPITAL
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Covered Entity Details
Entity Name
NEW YORK-PRESBYTERIAN HOSPITAL
Subdivision Name
UNIVERSITY HOSP OF COLUMBIA & CORNELL
Type
Disproportionate Share Hospital
340B ID
DSH330101
Entity Address
525 East 68th Street
New York, NY 10065
Medicare Provider Number
330101
Participating Start Date
4/1/2003
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #10912
2575 BROADWAY
NEW YORK, NY 10025
Pharmacy Comments
Contract Details
Approval Date
1/21/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
KAROL WOLLENBURG, VP, PHARMACY SERVICES
(212) 305-6592
Contract Pharmacy Representative
Signed By Date
1/21/2015
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