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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 # 04834
1225 UNION BLVD
ST LOUIS, MO 63113
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
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
7/7/2020
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