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WALGREENS SPECIALTY PHARMACY, LLC
CH10717A PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
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Covered Entity Details
Entity Name
PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Subdivision Name
Peninsula Community Health Services of Alaska
Type
HRSA-Funded Health Center
340B ID
CH10717A
Entity Address
230 East Marydale Ave
SOLDOTNA, AK 99669-7524
Grant Number
H80CS01139
Participating Start Date
10/1/2015
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR, STE 1
BEAVERTON, OR 97008
Pharmacy Comments
Contract Details
Approval Date
7/9/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Jennifer Lynn Youngberg, CFO
(907) 260-7312
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/9/2019
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