Contract Pharmacy Details

WALGREEN CO.
CHC26514-00 TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Covered Entity Details

Entity Name

TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Subdivision Name

TAPM Pediatrics at Wendover

Type

HRSA-Funded Health Center

340B ID

CHC26514-00

Entity Address

1046 E Wendover Ave
Greensboro, NC 27405-6712

Grant Number

H80CS26514

Participating Start Date

1/1/2015

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #21352
2913 E MARKET ST
GREENSBORO, NC 27405

Pharmacy Comments

Contract Details

Approval Date

7/9/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michelle Lewis, CEO
(336) 355-9715

Contract Pharmacy Representative

Walgreens
Andrea Koper, 340B Client Relations
(847) 964-6077

Signed By Date

7/9/2018

340B Drug Pricing Program Database