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WALGREEN CO.
FQHCLA363 Sharon Lee Family Health Care, Inc.
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Covered Entity Details
Entity Name
Sharon Lee Family Health Care, Inc.
Subdivision Name
Sharon Lee Family Health Care Rosedale
Type
Health Center Program Look-Alike
340B ID
FQHCLA363
Entity Address
340 Southwest Boulevard
Kansas city, KS 66103-2150
Grant Number
LALCS31530
Participating Start Date
4/1/2018
Last Recertification Date
2/2/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04236
2261 S STERLING AVE
INDEPENDENCE, MO 64052
Pharmacy Comments
Contract Details
Approval Date
5/10/2018
Contract Begin Date
5/11/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sharon D Lee, President
(913) 362-0220
Contract Pharmacy Representative
Walgreens Co
Herman Ratliff, 340B Client Relationship Analyst
(847) 964-8372
Signed By Date
5/10/2018
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