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WALGREEN CO.
FQHCLA417 INFANT WELFARE SOCIETY OF CHICAGO
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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 #15992
2500 N CLARK ST
CHICAGO, IL 60614
Pharmacy Comments
Contract Details
Approval Date
12/30/2020
Contract Begin Date
12/31/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2021
Business decision by covered entity and/or pharmacy
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
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