Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH220077 BAYSTATE MEDICAL CENTER

Covered Entity Details

Entity Name

BAYSTATE MEDICAL CENTER

Subdivision Name

BAYSTATE NORTH CAMPUS

Type

Disproportionate Share Hospital

340B ID

DSH220077

Entity Address

759 CHESTNUT STREET
SPRINGFIELD, MA 01199

Medicare Provider Number

220077

Participating Start Date

7/1/2003

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS # 03625
707 STATE ST.
SPRINGFIELD, MA 01109

Pharmacy Comments

Contract Details

Approval Date

8/13/2012

Contract Begin Date

8/13/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/21/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Dennis Chalke, Sr. VP Finance & Community Hospitals/CFO & Treasurer
(413) 794-3290

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

8/8/2012

340B Drug Pricing Program Database