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WALGREEN CO.
CH0512780 Tapestry 360 Health
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Covered Entity Details
Entity Name
Tapestry 360 Health
Subdivision Name
Tapestry 360 Health - Administration
Type
HRSA-Funded Health Center
340B ID
CH0512780
Entity Address
1301 W Devon Ave
Chicago, IL 60660
Grant Number
H80CS00215
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS 16299
331 W. SURF ST.
SUITE 101
CHICAGO, IL 60657-7160
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/28/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Gwenn Rausch, CEO
(773) 296-7587
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/11/2019
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