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WALGREEN CO.
FQHCLA211 HEALTH CENTERS DETROIT MEDICAL GROUP
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Covered Entity Details
Entity Name
HEALTH CENTERS DETROIT MEDICAL GROUP
Subdivision Name
ADMINISTRATIVE
Type
Health Center Program Look-Alike
340B ID
FQHCLA211
Entity Address
4201 ST ANTOINE BLVD, 9D
DETROIT, MI 48201-2153
Grant Number
LALCS00008
Participating Start Date
1/1/2007
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS #21209
3990 JOHN R ST., STE 1460
DETROIT, MI 48201-2018
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
HERBERT C. SMITHERMAN, PRESIDENT AND CEO
(313) 966-5187
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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