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WALGREEN EASTERN CO., INC.
DSH070022 YALE NEW HAVEN HOSPITAL
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Covered Entity Details
Entity Name
YALE NEW HAVEN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070022
Entity Address
20 York Street
New Haven, CT 06510
Medicare Provider Number
070022
Participating Start Date
7/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #13969
55 PARK ST STE 1A
NEW HAVEN, CT 06511
Pharmacy Comments
Contract Details
Approval Date
12/30/2010
Contract Begin Date
2/14/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
12/17/2010
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