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WALGREEN CO.
FQHCLA361C Adult and Child Health Inc
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Covered Entity Details
Entity Name
Adult and Child Health Inc
Subdivision Name
Adult and Child Health - Garfield Park
Type
Health Center Program Look-Alike
340B ID
FQHCLA361C
Entity Address
234 E Southern Ave
Indianapolis, IN 46225
Grant Number
LALCS31537
Participating Start Date
10/1/2019
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS #16558
1400 N RITTER AVE.
SUITE 140
INDIANAPOLIS, IN 46219
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dan Arens, Chief Operating Officer
(317) 893-0336
Contract Pharmacy Representative
Adult and Child Health
Dan Arens, Chief Operating Officer
(317) 893-0336
Signed By Date
7/1/2019
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