Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH220116 TUFTS MEDICAL CENTER

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 # 06767
625 MASSACHUSETTS AVE
CAMBRIDGE, MA 02139-3301

Pharmacy Comments

Contract Details

Approval Date

11/27/2012

Contract Begin Date

11/27/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/27/2025
Pharmacy closed

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

340B Drug Pricing Program Database