Contract Pharmacy Details

WALGREEN CO.
CH052900 COMMUNITY ACTION COMMITTEE OF PIKE COUNTY

Covered Entity Details

Entity Name

COMMUNITY ACTION COMMITTEE OF PIKE COUNTY

Subdivision Name

N/A

Type

HRSA-Funded Health Center

340B ID

CH052900

Entity Address

941 MARKET STREET
PIKETON, OH 45661

Grant Number

H80CS00399

Participating Start Date

12/1/1992

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12476
521 EAST MAIN STREET
JACKSON, OH 45640

Pharmacy Comments

Contract Details

Approval Date

7/14/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/7/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Gary B. Roberts, Executive Director
(740) 289-2371

Contract Pharmacy Representative

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

Signed By Date

7/14/2016

340B Drug Pricing Program Database