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WALGREEN EASTERN CO., INC.
DSH220116 TUFTS MEDICAL CENTER
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Covered Entity Details
Entity Name
TUFTS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220116
Entity Address
800 WASHINGTON STREET
BOSTON, MA 02111
Medicare Provider Number
220116
Participating Start Date
10/1/2003
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #15001
980 AMERICAN LEGION HWY
ROSLINDALE, MA 02131-4701
Pharmacy Comments
02/25/2013 corrected address error (was store #05756); 11/05/2012 store relocation (was Walgreens #1849 972 AMERICAN LEGION HWY ROSLINDALE MA 02131)
Contract Details
Approval Date
11/27/2012
Contract Begin Date
11/27/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chibueze Agba, CFO
(617) 636-4242
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/27/2012
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