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WALGREEN CO.
STD60603 Planned Parenthood of Illinois
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Covered Entity Details
Entity Name
Planned Parenthood of Illinois
Subdivision Name
Loop Health Center
Type
Sexually Transmitted Diseases
340B ID
STD60603
Entity Address
17 N. State Street
Suite 500
CHICAGO, IL 60602
Grant Number
NH25PS005138
Participating Start Date
10/1/2018
Last Recertification Date
5/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05719
4995 E US ROUTE 36
DECATUR, IL 62521
Pharmacy Comments
Contract Details
Approval Date
7/11/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Contacts
Covered Entity Signing Official
Megan Higdon, Medical Services Program Manager
(312) 592-6854
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2013
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