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WALGREEN CO
CH07720A ADVOCATES FOR A HEALTHY COMMUNITY INC
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Covered Entity Details
Entity Name
ADVOCATES FOR A HEALTHY COMMUNITY INC
Subdivision Name
Jordan Valley Community Health Center - Tampa
Type
HRSA-Funded Health Center
340B ID
CH07720A
Entity Address
440 E Tampa St
Springfield, MO 65806-1131
Grant Number
H80CS00275
Participating Start Date
10/1/2003
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12268
101 INDUSTRIAL PARK DRIVE
HOLLISTER, MO 65672
Pharmacy Comments
Contract Details
Approval Date
4/16/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brooks K. Miller, CEO
(417) 851-1551
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2017
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