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WALGREEN CO.
CHC08772-00 GRACEMED HEALTH CLINIC, INC.
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Covered Entity Details
Entity Name
GRACEMED HEALTH CLINIC, INC.
Subdivision Name
GraceMed Main Health Clinic
Type
HRSA-Funded Health Center
340B ID
CHC08772-00
Entity Address
1122 N Topeka St
Wichita, KS 67214-2810
Grant Number
H80CS08772
Participating Start Date
4/1/2005
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16517
803 N BROADWAY AVE
WICHITA, KS 67214
Pharmacy Comments
Contract Details
Approval Date
7/2/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID C. SANFORD, CEO
(316) 494-2001
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/2/2018
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