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WALGREEN CO.
CHC28965-02 FORDLAND CLINIC
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Covered Entity Details
Entity Name
FORDLAND CLINIC
Subdivision Name
FORDLAND CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC28965-02
Entity Address
11863 State Hwy 13
Kimberling City, MO 65686
Grant Number
H80CS28965
Participating Start Date
4/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16534
1500 E SUNSHINE ST STE 148
SPRINGFIELD, MO 65804
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
6/1/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Joan Twiton, Exec. Director
(417) 767-2273 Ext: 2022
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2019
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