Contract Pharmacy Details

WALGREEN CO
FP60462 Planned Parenthood of Illinois

Covered Entity Details

Entity Name

Planned Parenthood of Illinois

Subdivision Name

Orland Park Health Center

Type

Family Planning (Title X only)

340B ID

FP60462

Entity Address

14470 South La Grange Road
Suite 101
Orland Park, IL 60462

Grant Number

FPHPA006456-01-00

Participating Start Date

1/1/2016

Last Recertification Date

6/7/2019

Entity Termination Date

1/6/2020

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #09334
2986 KIRK RD
AURORA, IL 60502-6000

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