Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH310075 MONMOUTH MEDICAL CENTER

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 # 01315
2353 LAKEWOOD RD
TOMS RIVER, NJ 08755

Pharmacy Comments

Contract Details

Approval Date

4/11/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2019
Business decision by covered entity and/or pharmacy

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

340B Drug Pricing Program Database