Contract Pharmacy Details

WALGREEN CO.
CH036640 CHASE BREXTON HEALTH SERVICES, INC

Covered Entity Details

Entity Name

CHASE BREXTON HEALTH SERVICES, INC

Subdivision Name

Chase Brexton Health Services, Inc.

Type

HRSA-Funded Health Center

340B ID

CH036640

Entity Address

1111 North Charles Street
Baltimore, MD 21201-5505

Grant Number

H80CS00734

Participating Start Date

4/1/1997

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #19401
711 W 40TH ST
BALTIMORE, MD 21211-2120

Pharmacy Comments

Contract Details

Approval Date

4/4/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/3/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Robin Brooks, CFO
(410) 752-0954 Ext: 1148

Contract Pharmacy Representative

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

Signed By Date

4/4/2019

340B Drug Pricing Program Database