Contract Pharmacy Details

WALGREEN CO.
HV00708 MATTHEW 25 AIDS SERVICES, INC.

Covered Entity Details

Entity Name

MATTHEW 25 AIDS SERVICES, INC.

Subdivision Name

Type

Ryan White Part C

340B ID

HV00708

Entity Address

452 Old Corydon Rd.
Henderson, KY 42420

Grant Number

H76HA00708

Participating Start Date

4/1/2002

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04448
1145 U.S. 31 W. BYPASS
BOWLING GREEN, KY 42101

Pharmacy Comments

Contract Details

Approval Date

4/7/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Cynthia T. Burton, Administrator
(270) 826-0200

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/7/2014

340B Drug Pricing Program Database