340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
CH07440A DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Print
Covered Entity Details
Entity Name
DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Subdivision Name
DOUGLAS COUNTY PUBLIC HEALTH
Type
HRSA-Funded Health Center
340B ID
CH07440A
Entity Address
504 W. Broadway Ave.
AVA, MO 65608-1359
Grant Number
H80CS00457
Participating Start Date
4/1/2004
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
FORBES PHARMACY #15722, POWERED BY WALGR
100 NORTH GRAND
HOUSTON, MO 65483
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/29/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Tim R Shryack, CEO
(417) 683-4831 Ext: 110
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session