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WALGREEN CO.
CH034180 SOUTHERN DOMINION HEALTH SYSTEMS, INC.
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Covered Entity Details
Entity Name
SOUTHERN DOMINION HEALTH SYSTEMS, INC.
Subdivision Name
ADMINISTRATIVE OFFICE
Type
HRSA-Funded Health Center
340B ID
CH034180
Entity Address
1508 K-V ROAD
VICTORIA, VA 23974
Grant Number
H80CS00173
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17429
1401 S. MAIN STREET
FARMVILLE, VA 23901
Pharmacy Comments
Contract Details
Approval Date
4/9/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jill Seamans, CFO
(434) 696-2165
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/9/2019
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