Contract Pharmacy Details

WALGREEN CO.
FQHCLA130 HOWARD BROWN HEALTH CENTER

Covered Entity Details

Entity Name

HOWARD BROWN HEALTH CENTER

Subdivision Name

Type

Health Center Program Look-Alike

340B ID

FQHCLA130

Entity Address

4025 NORTH SHERIDAN ROAD
CHICAGO, IL 60613

Grant Number

LALCS00066

Participating Start Date

7/1/2003

Last Recertification Date

2/12/2016

Entity Termination Date

10/1/2016

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03949
3046 N HALSTED ST
CHICAGO, IL 60657

Pharmacy Comments

Contract Details

Approval Date

12/21/2010

Contract Begin Date

12/22/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2016

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

12/14/2010

340B Drug Pricing Program Database