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WALGREEN EASTERN CO., INC.
STD19147 Mazzoni Center
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Covered Entity Details
Entity Name
Mazzoni Center
Subdivision Name
STD Services
Type
Sexually Transmitted Diseases
340B ID
STD19147
Entity Address
1348 Bainbridge Street
PHILADELPHIA, PA 19147
Grant Number
6NU62PS924545
Participating Start Date
10/1/2018
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 07543
2310 W OREGON AVE
PHILADELPHIA, PA 19145-4122
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ronald Powers, COO
(215) 563-0652 Ext: 210
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/8/2018
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