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WALGREEN CO.
CH051020 HACKLEY COMMUNITY CARE CENTER INC
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Covered Entity Details
Entity Name
HACKLEY COMMUNITY CARE CENTER INC
Subdivision Name
Hackley Community Care Baker Site
Type
HRSA-Funded Health Center
340B ID
CH051020
Entity Address
2700 Baker St
Muskegon, MI 49444-2157
Grant Number
H80CS00684
Participating Start Date
1/1/2001
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06279
1991 E APPLE AVE
MUSKEGON, MI 49442
Pharmacy Comments
Contract Details
Approval Date
7/18/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA Collis JUAREZ, CEO
(231) 737-1335
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/18/2014
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