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WALGREEN EASTERN CO., INC.
DSH330194 MAIMONIDES MEDICAL CENTER
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Covered Entity Details
Entity Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330194
Entity Address
4802 TENTH AVE.
BROOKLYN, NY 11219
Medicare Provider Number
330194
Participating Start Date
10/1/2004
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #10092
2101 CHURCH AVE.
BROOKLYN, NY 11226-3909
Pharmacy Comments
Contract Details
Approval Date
7/17/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
PAMELA BRIER, CEO
(718) 283-6009
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2014
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