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WALGREEN CO.
RW400069 WASHINGTON UNIVERSITY IN ST. LOUIS
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Covered Entity Details
Entity Name
WASHINGTON UNIVERSITY IN ST. LOUIS
Subdivision Name
The SPOT
Type
Ryan White Part D
340B ID
RW400069
Entity Address
4169 LACLEDE AVENUE
ST. LOUIS, MO 63108-2812
Grant Number
H12HA24842
Participating Start Date
1/1/2020
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04834
1225 UNION BLVD
ST LOUIS, MO 63113
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/28/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Kimberly Jean Donica, Project Director
(314) 535-7275 Ext: 202
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2020
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