Contract Pharmacy Details

WALGREEN CO.
FP606289 PLANNED PARENTHOOD OF ILLINOIS

Covered Entity Details

Entity Name

PLANNED PARENTHOOD OF ILLINOIS

Subdivision Name

ROSELAND HEALTH CENTER

Type

Family Planning (Title X only)

340B ID

FP606289

Entity Address

11250 S HALSTED STREET
CHICAGO, IL 60628

Grant Number

FPHPA006456-01-00

Participating Start Date

1/1/1998

Last Recertification Date

6/7/2019

Entity Termination Date

1/6/2020

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07362
2379 PLAINFIELD RD
CREST HILL, IL 60403

Pharmacy Comments

Contract Details

Approval Date

10/1/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/6/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Richard Powell, Chief Financial Officer
(312) 592-6878

Contract Pharmacy Representative

Walgreens
Brenda Motley, Operations Analyst
(847) 964-7033

Signed By Date

10/1/2019

340B Drug Pricing Program Database