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WALGREEN CO
CH02371C INSTITUTE FOR FAMILY HEALTH, THE
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Covered Entity Details
Entity Name
INSTITUTE FOR FAMILY HEALTH, THE
Subdivision Name
SIDNEY HILLMAN and PHILLIPS FAMILY PRACTICE
Type
HRSA-Funded Health Center
340B ID
CH02371C
Entity Address
16 EAST 16TH STREET FL 3RD FLOOR
NEW YORK, NY 10003-3105
Grant Number
H80CS00768
Participating Start Date
1/1/2002
Last Recertification Date
2/15/2017
Entity Termination Date
1/1/2018
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS
28727 OREGON ROAD
PERRYSBURG, OH 43551
Pharmacy Comments
ATTN: C II manager
Contract Details
Approval Date
2/21/2013
Contract Begin Date
2/21/2013
Carve-In Effective Date
Contract Comments
02/21/2013 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
7/15/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Peter Grisafi, Senior Vice President & COO
(212) 633-0800 Ext: 1225
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/21/2013
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