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WALGREEN EASTERN CO., INC.
DSH220011 CAMBRIDGE PUBLIC HEALTH COMMISSION
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Covered Entity Details
Entity Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220011
Entity Address
1493 Cambridge Street
CAMBRIDGE, MA 02139
Medicare Provider Number
220011
Participating Start Date
7/1/1998
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 09538
2275 WASHINGTON ST
ROXBURY, MA 02119-3212
Pharmacy Comments
Contract Details
Approval Date
6/29/2012
Contract Begin Date
6/29/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gordon Boudrow, CFO
(781) 306-8851
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/29/2012
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