Contract Pharmacy Details

WALGREEN CO.
RWI606401B UI Health Community Clinic Network

Covered Entity Details

Entity Name

UI Health Community Clinic Network

Subdivision Name

South Side (West Englewood)

Type

Ryan White Part A

340B ID

RWI606401B

Entity Address

1606 W 63rd Street
Chicago, IL 60636

Grant Number

H89HA00008

Participating Start Date

10/1/2019

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15004
953 W. IRVING PARK RD.
CHICAGO, IL 60613

Pharmacy Comments

Contract Details

Approval Date

4/10/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Richard M. Novak, Chief, Division of Infectious Diseases/Ryan White Part A and C Project Director
(312) 996-6763

Contract Pharmacy Representative

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

Signed By Date

4/10/2020

340B Drug Pricing Program Database