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WALGREEN EASTERN CO., INC.
CH020870 NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
Subdivision Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH020870
Entity Address
61 Delano St
Pulaski, NY 13142-1400
Grant Number
H80CS00166
Participating Start Date
10/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19814
3035 EAST AVE
CENTRAL SQUARE, NY 13036-2611
Pharmacy Comments
Contract Details
Approval Date
4/2/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/27/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Tracy L Wimmer, VP/Chief Financial Officer
(315) 298-6569 Ext: 2020
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/2/2018
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