Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH220063 THE LOWELL GENERAL HOSPITAL

Covered Entity Details

Entity Name

THE LOWELL GENERAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220063

Entity Address

295 VARNUM AVENUE
LOWELL, MA 01854

Medicare Provider Number

220063

Participating Start Date

4/1/2004

Last Recertification Date

9/12/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #11726
1765 MIDDLESEX ST.
LOWELL, MA 01851

Pharmacy Comments

Contract Details

Approval Date

1/11/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/1/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Susan Green, Chief Financial Officer
(978) 788-7143

Contract Pharmacy Representative

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

Signed By Date

1/11/2018

340B Drug Pricing Program Database