Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH310076 SAINT BARNABAS MEDICAL CENTER

Covered Entity Details

Entity Name

SAINT BARNABAS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH310076

Entity Address

94 OLD SHORT HILLS RD
LIVINGSTON, NJ 07039-5668

Medicare Provider Number

310076

Participating Start Date

1/1/2017

Last Recertification Date

11/20/2017

Entity Termination Date

7/1/2018

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS # 03146
561-579 IRVINGTON AVENUE
NEWARK, NJ 07106

Pharmacy Comments

06/11/2012 changed address (was 561 Irvington Avenue, #579)

Contract Details

Approval Date

4/17/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Richard Davis, Chief Financial Officer
(973) 322-5612

Contract Pharmacy Representative

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

Signed By Date

4/17/2017

340B Drug Pricing Program Database