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WALGREEN EASTERN CO., INC
DSH330250 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
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Covered Entity Details
Entity Name
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330250
Entity Address
75 BEEKMAN STREET
PLATTSBURGH, NY 12901
Medicare Provider Number
330250
Participating Start Date
6/3/2019
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC
Pharmacy Address
WALGREENS #17756
40 SKYWAY SHOPPING CTR.
PLATTSBURGH, NY 12901-3873
Pharmacy Comments
Contract Details
Approval Date
3/8/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
SCOTT ST. GEORGE, SENIOR VICE PRESIDENT/CHIEF FINANCIAL OFFICER
(518) 562-7047
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/8/2018
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