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WALGREEN CO.
CHC33649-01 INNER CITY MUSLIM ACTION NETWORK
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Covered Entity Details
Entity Name
INNER CITY MUSLIM ACTION NETWORK
Subdivision Name
IMAN - Youth and Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC33649-01
Entity Address
2749 W 63rd St
Chicago, IL 60629-2342
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
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