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WALGREEN CO.
CH0514720 RAPHAEL HEALTH CENTER, Inc.
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Covered Entity Details
Entity Name
RAPHAEL HEALTH CENTER, Inc.
Subdivision Name
RAPHAEL HEALTH CENTER, Inc.
Type
HRSA-Funded Health Center
340B ID
CH0514720
Entity Address
401 E 34th St
Indianapolis, IN 46205-3754
Grant Number
H80CS00266
Participating Start Date
7/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS SPECIALTY PHARMACY #15323
9002 N MERIDIAN ST STE 213
INDIANAPOLIS, IN 46260
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dee Roudebush, CEO
(317) 860-3961
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2016
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