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WALGREEN CO.
CH058870 COUNTY OF LAKE
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Covered Entity Details
Entity Name
COUNTY OF LAKE
Subdivision Name
Grand Avenue Health Center
Type
HRSA-Funded Health Center
340B ID
CH058870
Entity Address
3010 Grand Avenue
Waukegan, IL 60085-2321
Grant Number
H80CS00119
Participating Start Date
1/1/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01033
811 GREEN BAY ROAD
WILMETTE, IL 60091
Pharmacy Comments
Contract Details
Approval Date
4/22/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/9/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tony Beltran, Executive Director
(847) 377-8703
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/22/2015
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