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WALGREEN EASTERN CO., INC.
DSH310019 St. Joseph’s University Medical Center
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Covered Entity Details
Entity Name
St. Joseph’s University Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310019
Entity Address
703 MAIN STREET
PATERSON, NJ 07503
Medicare Provider Number
310019
Participating Start Date
10/1/2002
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 06162
508 MARTIN LUTHER KING
EAST ORANGE, NJ 07018-2207
Pharmacy Comments
06/11/2012 changed address (was 508 Martin Luther King)
Contract Details
Approval Date
7/13/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/26/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William McDonald, President and CEO
(973) 754-2002
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2013
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