Contract Pharmacy Details

WALGREEN CO.
CHC30718-02 SIGNATURE HEALTH, INC.

Covered Entity Details

Entity Name

SIGNATURE HEALTH, INC.

Subdivision Name

Signature Health, Inc. Willoughby Clinic

Type

HRSA-Funded Health Center

340B ID

CHC30718-02

Entity Address

38882 Mentor Avenue
Willoughby, OH 44094-7875

Grant Number

H80CS30718

Participating Start Date

4/1/2017

Last Recertification Date

2/11/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 21252
16100 LAKE SHORE BLVD
CLEVELAND, OH 44110-1001

Pharmacy Comments

Contract Details

Approval Date

1/15/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jonathan Albert Lee, CEO
(440) 953-9999 Ext: 705133

Contract Pharmacy Representative

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

Signed By Date

1/15/2019

340B Drug Pricing Program Database