Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
FQHCLA334AD NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Covered Entity Details

Entity Name

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Subdivision Name

Segundo Ruiz Belvis Diagnostic and Treatment Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA334AD

Entity Address

545 E 142nd St
Bronx, NY 10454-2110

Grant Number

LALCS00169

Participating Start Date

7/1/2015

Last Recertification Date

2/8/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS
2817 THIRD AVE.
BRONX, NY 10455

Pharmacy Comments

Contract Details

Approval Date

7/12/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/3/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479

Contract Pharmacy Representative

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

Signed By Date

7/12/2016

340B Drug Pricing Program Database