Contract Pharmacy Details

WALGREEN CO.
HV00112A DAMIEN CENTER INC, THE

Covered Entity Details

Entity Name

DAMIEN CENTER INC, THE

Subdivision Name

Type

Ryan White Part C

340B ID

HV00112A

Entity Address

Damien Pharmacy, 8902 E 38th St, Indianapolis, IN
Indianapolis, IN 46226

Grant Number

H76HA45371

Participating Start Date

4/1/2021

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS SPECIALTY PHARMACY #16317
335 MASSACHUSETTS AVENUE
INDIANAPOLIS, IN 46204

Pharmacy Comments

Contract Details

Approval Date

4/7/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Alan Witchey, President and CEO
(317) 632-0123 Ext: 266

Contract Pharmacy Representative

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

Signed By Date

4/7/2021

340B Drug Pricing Program Database