340B Drug Pricing Program Database
Walgreens Central Fill #21394
RWI63139 Southampton Community Healthcare, Inc - information as of 6/21/2025 12:52:56 AM
Covered Entity Details
Entity Name
Southampton Community Healthcare, Inc
Subdivision Name
Type
Ryan White Part A
340B ID
RWI63139
Entity Address
2340 Hampton Ave
Saint Louis, MO 63139
Grant Number
H89HA00033
Participating Start Date
1/1/2023
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
Walgreens Central Fill #21394
Pharmacy Address
2601 Hughes Road
Suite 103
Liberty, MO 64068
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David James Prelutsky, President
(314) 276-3090
Contract Pharmacy Representative
Walgreen Co
Bradley Hedstrom, Account Manager Health Systems
(224) 515-6021
Signed By Date
1/17/2023
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