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WALGREEN EASTERN CO INC
DSH310075 MONMOUTH MEDICAL CENTER
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Covered Entity Details
Entity Name
MONMOUTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310075
Entity Address
300 SECOND AVENUE
LONG BRANCH, NJ 07740
Medicare Provider Number
310075
Participating Start Date
10/1/2004
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO INC
Pharmacy Address
DBA: WALGREENS #13717
375 STATE ROUTE 36
PORT MONMOUTH, NJ 07758
Pharmacy Comments
Contract Details
Approval Date
4/11/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
FRANK VOZOS, CEO
(732) 923-7504
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2013
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