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WALGREEN CO.
CH07055A Primary Health Care, Inc.
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Covered Entity Details
Entity Name
Primary Health Care, Inc.
Subdivision Name
Primary Health Care - Bery Engebretsen Clinic
Type
HRSA-Funded Health Center
340B ID
CH07055A
Entity Address
2353 SE 14th St
Des Moines, IA 50320-1109
Grant Number
H80CS00715
Participating Start Date
7/1/2002
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05060
12753 UNIVERSITY AVE
CLIVE, IA 50325
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Huntsman, CEO
(515) 248-1441
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2015
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