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WALGREEN CO.
CH05103B TCA HEALTH, INC. NFP
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Covered Entity Details
Entity Name
TCA HEALTH, INC. NFP
Subdivision Name
Mobile Student Health Clinic, Parking Lot B
Type
HRSA-Funded Health Center
340B ID
CH05103B
Entity Address
1029 East 130th St., Pkg Lot B
Chicago, IL 60628-6062
Grant Number
H80CS00109
Participating Start Date
4/1/2020
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10485
12854 S ASHLAND AVE
CALUMET PARK, IL 60827-6308
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
VERONICA CLARKE, CEO
(773) 995-6300 Ext: 213
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2020
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