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 # 06270
1001 W BELMONT
CHICAGO, IL 60657

Pharmacy Comments

Contract Details

Approval Date

10/15/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2016

Contacts

Covered Entity Signing Official

Magda Houlberg, SVP, COO Health Center Operations
(773) 388-8901

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/15/2015

340B Drug Pricing Program Database