Contract Pharmacy Details

WALGREEN CO.
CH100760 NORTHWEST HUMAN SERVICES, INC.

Covered Entity Details

Entity Name

NORTHWEST HUMAN SERVICES, INC.

Subdivision Name

Type

HRSA-Funded Health Center

340B ID

CH100760

Entity Address

681 CENTER STREET NE
SALEM, OR 97301

Grant Number

H80CS00148

Participating Start Date

10/1/2004

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11632
2150 FAIRGROUNDS RD. NE
SALEM, OR 97301

Pharmacy Comments

Contract Details

Approval Date

9/19/2012

Contract Begin Date

9/19/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

PAUL LOGAN, CEO
(503) 588-5828 Ext: 831

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

9/11/2012

340B Drug Pricing Program Database