Contract Pharmacy Details

WALGREEN CO.
CH05758U UNIVERSITY OF ILLINOIS

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

DBA: WALGREENS # 06002
1201 E STATE ST
ROCKFORD, IL 61104

Pharmacy Comments

Contract Details

Approval Date

7/24/2020

Contract Begin Date

7/28/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/19/2024
Pharmacy closed

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

340B Drug Pricing Program Database