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WALGREEN CO.
CH05675D Neighborhood HealthSource
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Covered Entity Details
Entity Name
Neighborhood HealthSource
Subdivision Name
North Metro Clinic
Type
HRSA-Funded Health Center
340B ID
CH05675D
Entity Address
10081 Dogwood Street NW STE 100
Coon Rapids, MN 55448-5281
Grant Number
H80CS00516
Participating Start Date
4/1/2020
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06714
2860 COON RAPIDS BLVD NW
COON RAPIDS, MN 55433
Pharmacy Comments
Contract Details
Approval Date
4/28/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven J. Knutson, Executive Director
(612) 287-2428
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/28/2020
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