Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH330202 KINGS COUNTY HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

KINGS COUNTY HOSPITAL CENTER (NYCHHC)

Subdivision Name

MAIN

Type

Disproportionate Share Hospital

340B ID

DSH330202

Entity Address

451 CLARKSON AVE.
BROOKLYN, NY 11203

Medicare Provider Number

330202

Participating Start Date

12/1/1992

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

WALGREENS # 18961
4123 AVENUE D
BROOKLYN, NY 11203-5705

Pharmacy Comments

Contract Details

Approval Date

3/29/2018

Contract Begin Date

3/29/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/9/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

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

Signed By Date

3/29/2018

340B Drug Pricing Program Database