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WALGREEN CO.
CH057110 THIRD STREET COMMUNITY CLINIC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
Third Street Community Clinic, Inc
Type
HRSA-Funded Health Center
340B ID
CH057110
Entity Address
600 W 3rd St
Mansfield, OH 44906-2633
Grant Number
H80CS00581
Participating Start Date
10/1/2001
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09047
1000 PARK AVE WEST
MANSFIELD, OH 44906
Pharmacy Comments
Contract Details
Approval Date
7/7/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peggy Anderson, CEO
(419) 526-7880
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/7/2021
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