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WALGREEN CO.
CH0518280 Stacy McKay Health & Education Center
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Covered Entity Details
Entity Name
Stacy McKay Health & Education Center
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH0518280
Entity Address
6450 US HWY 6
PORTAGE, IN 46368
Grant Number
H80CS02458
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12788
407 W. GLEN PARK AVENUE
GRIFFITH, IN 46319
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Hall, CEO
(219) 763-8112 Ext: 8002
Contract Pharmacy Representative
NorthShore Health Centers Inc.
Michael Wichlinski, Pharmacy Director
(219) 763-8112 Ext: 2301
Signed By Date
7/8/2020
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