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WALGREEN CO.
CHC10591-02 COMMUNITY CLINIC, INC.
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Covered Entity Details
Entity Name
COMMUNITY CLINIC, INC.
Subdivision Name
CCI-GAITHERSBURG
Type
HRSA-Funded Health Center
340B ID
CHC10591-02
Entity Address
220 GIRARD ST
Suite 100
GAITHERSBURG, MD 20877
Grant Number
H80CS10591
Participating Start Date
7/1/2009
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12846
6498 LANDOVER ROAD
CHEVERLY, MD 20785
Pharmacy Comments
Contract Details
Approval Date
10/1/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/25/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Sonya J. Bruton, CEO and President
(240) 839-5107
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/1/2020
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