Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH330246 ST. CHARLES HOSPITAL

Covered Entity Details

Entity Name

ST. CHARLES HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330246

Entity Address

200 BELLE TERRE ROAD
PORT JEFFERSON, NY 11777

Medicare Provider Number

330246

Participating Start Date

1/1/2011

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #09461
2215 MIDDLE COUNTRY RD.
CENTEREACH, NY 11720

Pharmacy Comments

Contract Details

Approval Date

1/6/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/30/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Ronald Weingartner, VP
(631) 474-6600

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/6/2017

340B Drug Pricing Program Database