Contract Pharmacy Details

WALGREEN CO.
HV00708A MATTHEW 25 AIDS SERVICES, INC.

Covered Entity Details

Entity Name

MATTHEW 25 AIDS SERVICES, INC.

Subdivision Name

Type

Ryan White Part C

340B ID

HV00708A

Entity Address

101 N.W. 1st Street Suite 215
Evansville, IN 47708

Grant Number

H76HA49240

Participating Start Date

7/1/2003

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS SPECIALTY PHARMACY #16317
335 MASSACHUSETTS AVENUE
INDIANAPOLIS, IN 46204

Pharmacy Comments

Contract Details

Approval Date

7/6/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Cynthia T. Burton, Administrator
(270) 826-0200

Contract Pharmacy Representative

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

Signed By Date

7/6/2016

340B Drug Pricing Program Database