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WALGREEN EASTERN CO., INC.
STD02860 CODAC Behavioral Healthcare Inc
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Covered Entity Details
Entity Name
CODAC Behavioral Healthcare Inc
Subdivision Name
CODAC Pawtucket
Type
Sexually Transmitted Diseases
340B ID
STD02860
Entity Address
600 Pawtucket Ave
Pawtucket, RI 02860
Grant Number
6 NH25PS0005160-02
Participating Start Date
7/1/2021
Last Recertification Date
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 06892
591 METACOM AVENUE
BRISTOL, RI 02809-5131
Pharmacy Comments
Contract Details
Approval Date
4/26/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Linda Hurley, CEO
(401) 275-5037
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/7/2021
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