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WALGREEN CO.
HV60120 OPEN DOOR CLINIC OF GREATER ELGIN
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Covered Entity Details
Entity Name
OPEN DOOR CLINIC OF GREATER ELGIN
Subdivision Name
Type
Ryan White Part C
340B ID
HV60120
Entity Address
1665 Larkin Ave
ELGIN, IL 60123
Grant Number
H76HA01704
Participating Start Date
10/1/2004
Last Recertification Date
2/28/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 00039
235 E PALATINE RD
ARLINGTON HEIGHTS, IL 60004
Pharmacy Comments
Contract Details
Approval Date
1/26/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
La Juan Baines, Executive Director
(847) 695-1093 Ext: 219
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/26/2021
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