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WALGREEN CO.
CH057260 KENOSHA COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
KENOSHA COMMUNITY HEALTH CENTER INC
Subdivision Name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH057260
Entity Address
4536 22nd Ave
Kenosha, WI 53140-5917
Grant Number
H80CS00662
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09605
1810 30TH AVE
KENOSHA, WI 53144-1437
Pharmacy Comments
Contract Details
Approval Date
7/2/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura Waldvogel, Interim ED
(262) 764-3607
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/2/2013
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