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WALGREEN CO.
CH051278V Tapestry 360 Health
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Covered Entity Details
Entity Name
Tapestry 360 Health
Subdivision Name
Tapestry 360 Health - Skokie
Type
HRSA-Funded Health Center
340B ID
CH051278V
Entity Address
8320 Skokie Blvd
Skokie, IL 60077-2545
Grant Number
H80CS00215
Participating Start Date
4/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06866
1378 MINER STREET
DES PLAINES, IL 60016-4389
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
Gwenn Rausch, CEO
(773) 296-7587
Contract Pharmacy Representative
Heartland International Health Center
Randall H Johnson, CFO
(773) 296-7683
Signed By Date
7/15/2020
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