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WALGREEN EASTERN CO., INC.
DSH310021 St Francis Medical Center
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Covered Entity Details
Entity Name
St Francis Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310021
Entity Address
601 Hamilton Ave
Trenton, NJ 08629
Medicare Provider Number
310021
Participating Start Date
4/1/2014
Last Recertification Date
8/25/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 07974
1096 ROUTE 33
HAMILTON, NJ 08690-2710
Pharmacy Comments
Contract Details
Approval Date
7/28/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Kelly, VP Finance/CFO
(609) 599-5119 Ext: 5119
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/28/2014
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