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WALGREENS SPECIALTY PHARMACY, LLC
CH010480 NORTHWEST COMMUNITY HEALTH CARE
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Covered Entity Details
Entity Name
NORTHWEST COMMUNITY HEALTH CARE
Subdivision Name
DBA WellOne Primary Medical and Dental Care
Type
HRSA-Funded Health Center
340B ID
CH010480
Entity Address
36 BRIDGE WAY
PASCOAG, RI 02859
Grant Number
H80CS00308
Participating Start Date
10/1/2003
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter Bancroft, President & CEO
(401) 285-5119
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2019
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