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WALGREEN CO.
FQHCLA346B Highland Health Providers Corporation
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Covered Entity Details
Entity Name
Highland Health Providers Corporation
Subdivision Name
Highland Health Providers - Lynchburg Medical Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA346B
Entity Address
8900 State Route 134
Lynchburg, OH 45142-9272
Grant Number
LALCS00180
Participating Start Date
7/1/2018
Last Recertification Date
2/10/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11158
1090 NORTHVIEW DR.
HILLSBORO, OH 45133
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amanda M Warix, Executive Director
(937) 393-5753
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2019
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