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WALGREEN CO.
CH078000 GREAT MINES HEALTH CENTER
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Covered Entity Details
Entity Name
GREAT MINES HEALTH CENTER
Subdivision Name
Great Mines Health Center
Type
HRSA-Funded Health Center
340B ID
CH078000
Entity Address
#1 Southtowne Dr.
Potosi, MO 63664
Grant Number
H80CS06670
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #15821
903 BENHAM
BONNE TERRE, MO 63628
Pharmacy Comments
Contract Details
Approval Date
11/6/2020
Contract Begin Date
11/6/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory Roeback, Chief Executive Officer
(573) 438-8380
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/6/2020
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