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WALGREEN CO.
STD63139 The CentralWest Immunologic Research Foundation
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Covered Entity Details
Entity Name
The CentralWest Immunologic Research Foundation
Subdivision Name
Hampton Site
Type
Sexually Transmitted Diseases
340B ID
STD63139
Entity Address
2340 Hampton Ave.
St. Louis, MO 63139
Grant Number
NH25PS005142
Participating Start Date
1/1/2020
Last Recertification Date
5/20/2020
Entity Termination Date
7/1/2021
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07144
3631 GRAVOIS AVE
SAINT LOUIS, MO 63116
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
4/27/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David Alan Parks, Vice President
(314) 882-8855
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2020
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