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WALGREEN CO.
URB10642 SEATTLE INDIAN HEALTH BOARD
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Covered Entity Details
Entity Name
SEATTLE INDIAN HEALTH BOARD
Subdivision Name
Type
Urban Indian
340B ID
URB10642
Entity Address
611 12TH AVE S
SEATTLE, WA 98144
Grant Number
Participating Start Date
12/1/1992
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #21167
747 BROADWAY AVE STE ET-144
SEATTLE, WA 98122
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Ryan Brooks Gilbert, Chief Operations Officer
(206) 324-9360 Ext: 1106
Contract Pharmacy Representative
Walgreens Co
Christina Hess, 340B Client Relationships
(847) 964-4000
Signed By Date
1/15/2020
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