Contract Pharmacy Details

WALGREEN CO.
URB162 AMERICAN INDIAN HEALTH SERVICE OF CHICAGO, INC.

Covered Entity Details

Entity Name

AMERICAN INDIAN HEALTH SERVICE OF CHICAGO, INC.

Subdivision Name

Type

Urban Indian

340B ID

URB162

Entity Address

4326 W. Montrose Ave
CHICAGO, IL 60641

Grant Number

Participating Start Date

7/1/2001

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12504
110 W 10TH ST
METROPOLIS, IL 62960

Pharmacy Comments

Contract Details

Approval Date

7/13/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

RoxAnne Marie LaVallie Unabia, Executive Director
(773) 883-9100 Ext: 1003

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/13/2021

340B Drug Pricing Program Database