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WALGREEN EASTERN CO., INC.
RRC330011-00 OUR LADY OF LOURDES MEMORIAL HOSP
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Covered Entity Details
Entity Name
OUR LADY OF LOURDES MEMORIAL HOSP
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330011-00
Entity Address
169 RIVERSIDE DRIVE
BINGHAMTON, NY 13905
Medicare Provider Number
330011
Participating Start Date
7/1/2024
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 10158
3948 ROUTE 281
CORTLAND, NY 13045-8851
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/9/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathryn Connerton, CEO
(607) 798-5328
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2016
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