Contract Pharmacy Details

WALGREEN CO.
FQHC638398 JAMESTOWN S'KLALLAM TRIBE

Covered Entity Details

Entity Name

JAMESTOWN S'KLALLAM TRIBE

Subdivision Name

Jamestown Family Health Clinic

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638398

Entity Address

808 N. 5th Avenue
SEQUIM, WA 98382

Grant Number

Participating Start Date

1/1/2001

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11215
932 E. FRONT ST.
PORT ANGELES, WA 98362

Pharmacy Comments

Contract Details

Approval Date

1/18/2012

Contract Begin Date

1/18/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ron W. Allen, CEO
(360) 683-1109

Contract Pharmacy Representative

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

Signed By Date

11/22/2011

340B Drug Pricing Program Database