Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH220163 UMASS MEMORIAL MEDICAL CENTER

Covered Entity Details

Entity Name

UMASS MEMORIAL MEDICAL CENTER

Subdivision Name

UNIVERSITY CAMPUS

Type

Disproportionate Share Hospital

340B ID

DSH220163

Entity Address

55 LAKE AVENUE NORTH
WORCESTER, MA 01655

Medicare Provider Number

220163

Participating Start Date

10/1/2003

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

WALGREENS #19506
178 MAIN ST
STURBRIDGE, MA 01566

Pharmacy Comments

Contract Details

Approval Date

3/2/2018

Contract Begin Date

3/2/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/17/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Alice Shakman, Vice President Operations
(774) 443-0540

Contract Pharmacy Representative

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

Signed By Date

3/2/2018

340B Drug Pricing Program Database