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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 #10256
1140 N. MAIN ST.
PROVIDENCE, RI 02904-1819
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
1/26/2016
Business decision by covered entity and/or pharmacy
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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