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WALGREEN CO.
CH0526690 Partnership Community Health Center
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Covered Entity Details
Entity Name
Partnership Community Health Center
Subdivision Name
Medical and Behavioral Health
Type
HRSA-Funded Health Center
340B ID
CH0526690
Entity Address
5471 Waterford Lane
Appleton, WI 54913-1110
Grant Number
H80CS04197
Participating Start Date
9/9/2005
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09699
925 W FULTON ST
WAUPACA, WI 54981-1479
Pharmacy Comments
Contract Details
Approval Date
7/18/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristene S Stacker, CEO
(920) 740-7280
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/18/2018
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