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WALGREEN CO.
CH053320 SIHF Healthcare
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Covered Entity Details
Entity Name
SIHF Healthcare
Subdivision Name
SIHF Healthcare
Type
HRSA-Funded Health Center
340B ID
CH053320
Entity Address
2041 Goose Lake Rd,
Sauget, IL 62206-2822
Grant Number
H80CS00195
Participating Start Date
7/1/2001
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05719
4995 E US ROUTE 36
DECATUR, IL 62521
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
Larry McCulley, President
(618) 332-0694 Ext: 155
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2019
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