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WALGREEN CO.
CH0627970 AMISTAD COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
AMISTAD COMMUNITY HEALTH CENTER
Subdivision Name
AMISTAD COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0627970
Entity Address
1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Grant Number
H80CS08778
Participating Start Date
4/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #16030
1105 US HWY 181
PORTLAND, TX 78374
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kenneth Waller, CEO
(361) 886-3090
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/13/2020
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