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WALGREEN EASTERN CO., INC.
DSH330096 JONES MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JONES MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330096
Entity Address
191 North Main Street
WELLSVILLE, NY 14895-0072
Medicare Provider Number
330096
Participating Start Date
10/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #17344
4175 STATE ROUTE 417
WELLSVILLE, NY 14895
Pharmacy Comments
Contract Details
Approval Date
3/14/2018
Contract Begin Date
3/14/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Helms, Vice President of Finance
(585) 596-4002
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/14/2018
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