Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
RWI07102 Saint Michael's Clinics, Inc.

Covered Entity Details

Entity Name

Saint Michael's Clinics, Inc.

Subdivision Name

Peter Ho Memorial Clinic

Type

Ryan White Part A

340B ID

RWI07102

Entity Address

111 Central Ave
Newark, NJ 07102

Grant Number

H89HA00003

Participating Start Date

7/1/2016

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #15594
465 KEARNY AVE
KEARNY, NJ 07032

Pharmacy Comments

Contract Details

Approval Date

4/6/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/22/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Robert Iannaccone, Executive Director
(973) 877-5350

Contract Pharmacy Representative

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

Signed By Date

4/6/2018

340B Drug Pricing Program Database