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WALGREEN EASTERN CO., INC.
DSH330056 THE BROOKLYN HOSPITAL CENTER
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Covered Entity Details
Entity Name
THE BROOKLYN HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330056
Entity Address
121 DEKALB AVE
BROOKLYN, NY 11201
Medicare Provider Number
330056
Participating Start Date
4/1/2005
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19994
1040 SAINT JOHNS PL.
BROOKLYN, NY 11213-2533
Pharmacy Comments
Contract Details
Approval Date
3/27/2018
Contract Begin Date
3/28/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/28/2018
Ownership change
Contacts
Covered Entity Signing Official
Donald P. Minarcik, VP Revenue Enhancement
(718) 488-3775
Contract Pharmacy Representative
The Brooklyn Hospital Center
Kathleen Minlionica, Director of Pharmacy, Per diem
(718) 250-8220
Signed By Date
3/27/2018
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