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WALGREEN EASTERN CO., INC
SCH330218-06 Oswego Hospital
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Covered Entity Details
Entity Name
Oswego Hospital
Subdivision Name
Fulton Medical Center Urgent Care
Type
Sole Community Hospital
340B ID
SCH330218-06
Entity Address
510 South Fourth Street
Fulton, NY 13069
Medicare Provider Number
330218
Outpatient Facility Provider Number
Participating Start Date
12/21/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC
Pharmacy Address
WALGREENS #17566
250 STATE ROUTE 104
OSWEGO, NY 13126
Pharmacy Comments
Contract Details
Approval Date
3/22/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric T. Campbell, CFO
(315) 349-5531
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/22/2018
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