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WALGREEN CO.
CH048980 LEWIS COUNTY PRIMARY CARE CENTER, INC.
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Covered Entity Details
Entity Name
LEWIS COUNTY PRIMARY CARE CENTER, INC.
Subdivision Name
Lewis County Primary Care Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH048980
Entity Address
211 KY 59
Building A
VANCEBURG, KY 41179
Grant Number
H80CS00106
Participating Start Date
1/1/1999
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19971
100 S CAROL MALONE BLVD
GRAYSON, KY 41143
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY UGRIN, CEO
(606) 796-3029
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2020
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