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WALGREEN CO.
TB84190 Salt Lake County Health Department
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Covered Entity Details
Entity Name
Salt Lake County Health Department
Subdivision Name
Type
Tuberculosis
340B ID
TB84190
Entity Address
2001 S State Street, Suite S2-600
Salt Lake City, UT 84190-2150
Grant Number
NU52PS004689
Participating Start Date
10/1/2017
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09238
531 EAST 400 SOUTH
SALT LAKE CITY, UT 84102
Pharmacy Comments
Contract Details
Approval Date
4/30/2018
Contract Begin Date
5/18/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Malaykhone Tair Kiphibane, Infectious Disease Bureau Manager
(385) 468-4276
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/30/2018
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