Contract Pharmacy Details

WALGREEN CO.
FQHCLA417 INFANT WELFARE SOCIETY OF CHICAGO

Covered Entity Details

Entity Name

INFANT WELFARE SOCIETY OF CHICAGO

Subdivision Name

IWS Family Health Logan Square

Type

Health Center Program Look-Alike

340B ID

FQHCLA417

Entity Address

3600 W FULLERTON AVE
CHICAGO, IL 60647-2319

Grant Number

LALCS40176

Participating Start Date

12/21/2020

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15004
953 W. IRVING PARK RD.
CHICAGO, IL 60613

Pharmacy Comments

Contract Details

Approval Date

12/30/2020

Contract Begin Date

12/31/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Karen Lynne Williams, Chief Financial Officer
(773) 782-5017

Contract Pharmacy Representative

Walgreens
Andrea Koper, 340B Client Relations
(847) 964-6077

Signed By Date

12/30/2020

340B Drug Pricing Program Database