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WALGREEN CO.
CHC26511-09 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Calumet Family Health Center- Calumet Ave
Type
HRSA-Funded Health Center
340B ID
CHC26511-09
Entity Address
56720 Calumet Ave.
Calumet, MI 49913
Grant Number
H80CS26511
Participating Start Date
1/1/2017
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #16254
1007 MEMORIAL RD
HOUGHTON, MI 49931
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2019
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