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WALGREEN CO.
STD462012 DAMIEN CENTER INC, THE
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Covered Entity Details
Entity Name
DAMIEN CENTER INC, THE
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD462012
Entity Address
26 N Arsenal Avenue
Indianapolis, IN 46201
Grant Number
NU62PS924804
Participating Start Date
10/1/2019
Last Recertification Date
5/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS SPECIALTY PHARMACY #16317
335 MASSACHUSETTS AVENUE
INDIANAPOLIS, IN 46204
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alan Witchey, President and CEO
(317) 632-0123 Ext: 266
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2019
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