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WALGREEN EASTERN CO., INC
FQHCLA334U NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
East New York Diagnostic and Treatment Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA334U
Entity Address
2094 Pitkin Ave
Brooklyn, NY 11207-3509
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
2/22/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC
Pharmacy Address
DBA: WALGREENS
1847 ROCKAWAY PKWY.
BROOKLYN, NY 11236-5307
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
4/1/2019
Covered Entity Terminated
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
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