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WALGREEN CO.
FP60610 Planned Parenthood of Illinois
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Covered Entity Details
Entity Name
Planned Parenthood of Illinois
Subdivision Name
Near North Health Center
Type
Family Planning (Title X only)
340B ID
FP60610
Entity Address
1200 N LaSalle Ave
Chicago, IL 60610
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 #15168
602 W. UNIVERSITY AVENUE
URBANA, IL 61801
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
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