Contract Pharmacy Details

WALGREEN CO.
CHC33649-01 INNER CITY MUSLIM ACTION NETWORK

Covered Entity Details

Entity Name

INNER CITY MUSLIM ACTION NETWORK

Subdivision Name

IMAN - Youth and Family Health Center

Type

HRSA-Funded Health Center

340B ID

CHC33649-01

Entity Address

2749 W 63rd St
Chicago, IL 60629-2342

Grant Number

H80CS33649

Participating Start Date

7/1/2020

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 10350
7109 S JEFFERY BLVD
CHICAGO, IL 60649-2425

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/27/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Sofia Adawy, Senior Health Center Director
(773) 434-4626

Contract Pharmacy Representative

Inner City Muslim Action Network
Nada Bowie, Senior Operations Manager
(773) 434-4626

Signed By Date

4/15/2021

340B Drug Pricing Program Database