Contract Pharmacy Details

WALGREEN CO.
CHC33649-00 INNER CITY MUSLIM ACTION NETWORK

Covered Entity Details

Entity Name

INNER CITY MUSLIM ACTION NETWORK

Subdivision Name

IMAN-Main Site

Type

HRSA-Funded Health Center

340B ID

CHC33649-00

Entity Address

2744 W 63rd St
Chicago, IL 60629-2343

Grant Number

H80CS33649

Participating Start Date

7/1/2020

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05724
7045 S PULASKI ROAD
CHICAGO, IL 60629-5833

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Sofia Adawy, Senior Health Center Director
(773) 434-4626

Contract Pharmacy Representative

Walgreens
Randy Levine, 340B Client Relationship Analyst
(847) 964-8162

Signed By Date

7/15/2020

340B Drug Pricing Program Database