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WALGREEN CO.
CHC33649-02 INNER CITY MUSLIM ACTION NETWORK
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Covered Entity Details
Entity Name
INNER CITY MUSLIM ACTION NETWORK
Subdivision Name
IMAN-Oral Health Center
Type
HRSA-Funded Health Center
340B ID
CHC33649-02
Entity Address
2744 W. 63rd St., Building #2
Chicago, IL 60629
Grant Number
H80CS33649
Participating Start Date
7/1/2020
Last Recertification Date
2/8/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 00089
8715 S HARLEM AVE
BRIDGEVIEW, IL 60455
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
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
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