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WALGREEN EASTERN CO., INC.
DSH330223 MASSENA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MASSENA MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330223
Entity Address
1 HOSPITAL DRIVE
MASSENA, NY 13662
Medicare Provider Number
330223
Participating Start Date
7/1/2010
Last Recertification Date
9/7/2016
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 10293
173 MARKET ST
POTSDAM, NY 13676-1221
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
4/15/2013
Carve-In Effective Date
Contract Comments
04/15/2013 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
4/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
SEAN M. CURTIN, CHIEF FINANCIAL OFFICER
(315) 769-4207
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2013
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