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WALGREEN CO.
RW400069 WASHINGTON UNIVERSITY IN ST. LOUIS
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Covered Entity Details
Entity Name
WASHINGTON UNIVERSITY IN ST. LOUIS
Subdivision Name
The SPOT
Type
Ryan White Part D
340B ID
RW400069
Entity Address
4169 LACLEDE AVENUE
ST. LOUIS, MO 63108-2812
Grant Number
H12HA24842
Participating Start Date
1/1/2020
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02994
9285 HALLS FERRY RD
JENNINGS, MO 63136
Pharmacy Comments
Contract Details
Approval Date
10/6/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kimberly Jean Donica, Project Director
(314) 535-7275 Ext: 202
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/6/2020
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