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WALGREEN CO.
CH05758U UNIVERSITY OF ILLINOIS
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Covered Entity Details
Entity Name
UNIVERSITY OF ILLINOIS
Subdivision Name
UI Health Mile Square Health Center L.P. Johnson Rockford
Type
HRSA-Funded Health Center
340B ID
CH05758U
Entity Address
1221 E State St
Rockford, IL 61104-2231
Grant Number
H80CS00324
Participating Start Date
6/22/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS PHARMACY AT CRUSADERS #21287
1200 W STATE ST STE 102
ROCKFORD, IL 61102-2112
Pharmacy Comments
Contract Details
Approval Date
7/24/2020
Contract Begin Date
7/28/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Moss, Associate Vice Chancellor, Budget & Financial Analysis
(312) 996-0306
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/24/2020
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