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WALGREEN CO
HV073390 KANSAS CITY FREE HEALTH CLINIC
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Covered Entity Details
Entity Name
KANSAS CITY FREE HEALTH CLINIC
Subdivision Name
Type
Ryan White Part C
340B ID
HV073390
Entity Address
3515 BROADWAY STREET
KANSAS CITY, MO 64111
Grant Number
H76HA00140
Participating Start Date
1/1/2005
Last Recertification Date
2/23/2017
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA WALGREENS
5100 LAKE TERRACE NE
MOUNT VERNON, IL 62864
Pharmacy Comments
Contract Details
Approval Date
2/28/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/28/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sally Neville, Director
(816) 777-2728
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2013
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