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WALGREEN EASTERN CO., INC.
DSH330259 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330259
Entity Address
1000 NORTH VILLAGE AVE
ROCKVILLE CENTRE, NY 11570
Medicare Provider Number
330259
Participating Start Date
1/1/2016
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 06823
1968 GRAND AVE
NORTH BALDWIN, NY 11510-2813
Pharmacy Comments
Contract Details
Approval Date
1/12/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Janine Beine, VP of Finance
(516) 705-1317
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2017
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