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WALGREEN EASTERN CO., INC
DSH330153 Ellis Hospital
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Covered Entity Details
Entity Name
Ellis Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330153
Entity Address
1101 Nott Street
Schenectady, NY 12308
Medicare Provider Number
330153
Participating Start Date
7/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC
Pharmacy Address
RITE AID #10696
1409 ALTAMONT
SCHENECTADY, NY 12303-2904
Pharmacy Comments
Contract Details
Approval Date
2/9/2018
Contract Begin Date
2/9/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/3/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Marc Mesick, CFO & VP of Finance
(518) 243-4144
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/9/2018
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