340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
CH050900 LA CLINICA DE LOS CAMPESINOS, INC.
Print
Covered Entity Details
Entity Name
LA CLINICA DE LOS CAMPESINOS, INC.
Subdivision Name
Noble Community Clinics - Wautoma
Type
HRSA-Funded Health Center
340B ID
CH050900
Entity Address
400 S. Townline Rd
WAUTOMA, WI 54982-1440
Grant Number
H80CS00713
Participating Start Date
4/1/1996
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09699
925 W FULTON ST
WAUPACA, WI 54981-1479
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/22/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Laura Waldvogel, CEO
(920) 787-9406
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session