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WALGREEN CO.
CH056750 NEIGHBORHOOD HEALTHSOURCE
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Covered Entity Details
Entity Name
NEIGHBORHOOD HEALTHSOURCE
Subdivision Name
FREMONT CLINIC
Type
HRSA-Funded Health Center
340B ID
CH056750
Entity Address
3300 Fremont Ave N
Minneapolis, MN 55412-2405
Grant Number
H80CS00516
Participating Start Date
1/1/2003
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02316
2024 85TH AVE N
BROOKLYN PARK, MN 55444-1495
Pharmacy Comments
Contract Details
Approval Date
2/22/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RON JANKOWSKI, CHIEF MEDICAL OFFICER
(612) 781-3837
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2013
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