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WALGREEN CO.
CH0510280 LAKE SUPERIOR COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Subdivision Name
LAKE SUPERIOR HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0510280
Entity Address
4325 Grand Ave
Duluth, MN 55807-2730
Grant Number
H80CS00811
Participating Start Date
10/1/2000
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15149
1609 KENWOOD AVENUE
DULUTH, MN 55811
Pharmacy Comments
Contract Details
Approval Date
7/21/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dayle Patterson, CEO
(218) 336-3580
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/21/2017
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