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WALGREEN CO.
CH05972AH AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
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Covered Entity Details
Entity Name
AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Subdivision Name
Southeast Side Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05972AH
Entity Address
3528 E 118th St
Chicago, IL 60617-7314
Grant Number
H80CS00685
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05192
9148 S COMMERCIAL AVE
CHICAGO, IL 60617
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Audrey Pennington, Chief Operating Officer
(708) 747-7100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2019
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