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WALGREEN CO.
FQHCLA361B Adult And Child Health Inc
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Covered Entity Details
Entity Name
Adult And Child Health Inc
Subdivision Name
Adult and Child Health - Greenwood
Type
Health Center Program Look-Alike
340B ID
FQHCLA361B
Entity Address
8320 Madison Ave
Indianapolis, IN 46227-6066
Grant Number
LALCS31537
Participating Start Date
1/1/2019
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02956
1808 ALBANY ST
BEECH GROVE, IN 46107
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dan Arens, Chief Operating Officer
(317) 893-0336
Contract Pharmacy Representative
Walgreens Co
Christina Hess, 340B Client Relationships
(847) 964-4000
Signed By Date
10/14/2019
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