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WALGREEN CO.
URB162 AMERICAN INDIAN HEALTH SERVICE OF CHICAGO, INC.
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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 # 02071
2020 S MAC ARTHUR BLVD
SPRINGFIELD, IL 62704
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
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