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WALGREEN EASTERN CO., INC.
DSH220011 CAMBRIDGE PUBLIC HEALTH COMMISSION
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Covered Entity Details
Entity Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220011
Entity Address
1493 Cambridge Street
CAMBRIDGE, MA 02139
Medicare Provider Number
220011
Participating Start Date
7/1/1998
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
RITE AID #10172
884 MAIN ST
MELROSE, MA 02176
Pharmacy Comments
Contract Details
Approval Date
4/4/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/14/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Andrew M Fuqua, Senior Vice President and General Counsel
(617) 665-1000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/4/2018
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