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WALGREEN CO
CH0515170 OAKLAND PRIMARY HEALTH SERVICES INC.
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Covered Entity Details
Entity Name
OAKLAND PRIMARY HEALTH SERVICES INC.
Subdivision Name
OAKLAND PRIMARY HEALTH SERVICES
Type
HRSA-Funded Health Center
340B ID
CH0515170
Entity Address
46156 Woodward Avenue
Pontiac, MI 48342
Grant Number
H80CS00283
Participating Start Date
1/1/2004
Last Recertification Date
1/25/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #09928
20 S TELEGRAPH RD
WATERFORD, MI 48328
Pharmacy Comments
Contract Details
Approval Date
1/21/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Victor C. Kirk, CEO
(248) 322-6747 Ext: 226
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/21/2014
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