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WALGREEN CO.
FQHC638347 SWINOMISH INDIAN TRIBAL COMM
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Covered Entity Details
Entity Name
SWINOMISH INDIAN TRIBAL COMM
Subdivision Name
Swinomish Health Clinics
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638347
Entity Address
17400 RESERVATION ROAD
LA CONNER, WA 98257
Grant Number
Participating Start Date
4/7/2021
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11300
623 S. BURLINGTON BLVD.
BURLINGTON, WA 98233
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
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Cheryl Rasar, Medical Director
(360) 466-3167 Ext: 7268
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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