Contract Pharmacy Details

WALGREEN CO.
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

JANE PAULEY COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Jane Pauley Community Health Center

Type

HRSA-Funded Health Center

340B ID

CHC26566-00

Entity Address

8931 E. 30th Street
Indianapolis, IN 46219-1501

Grant Number

H80CS26566

Participating Start Date

4/1/2014

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #21257
902 E HANNA AVE
INDIANAPOLIS, IN 46227

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

Dale Marion, 340B Program Manager
(317) 552-0690

Contract Pharmacy Representative

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

Signed By Date

7/2/2018

340B Drug Pricing Program Database