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WALGREEN CO
RW400069A WASHINGTON UNIVERSITY IN ST. LOUIS
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Covered Entity Details
Entity Name
WASHINGTON UNIVERSITY IN ST. LOUIS
Subdivision Name
Pediatric Youth HIV Clinic at St. Louis Children's Hospital
Type
Ryan White Part D
340B ID
RW400069A
Entity Address
ONE CHILDREN'S PLACE
SUITE C & D
SAINT LOUIS, MO 63110-1002
Grant Number
H12HA24842
Participating Start Date
4/1/2020
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12395
6607 STATE ROUTE 162
MARYVILLE, IL 62062
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
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
7/7/2020
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