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WALGREEN CO.
CH070890 SIOUXLAND COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
SIOUXLAND COMMUNITY HEALTH CENTER
Subdivision Name
SIOUXLAND COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH070890
Entity Address
1021 Nebraska St
Sioux City, IA 51105-1436
Grant Number
H80CS00535
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16528
1704 INGERSOLL AVE STE 102
DES MOINES, IA 50309
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARI E KAPTAIN-DAHLEN, CEO
(712) 202-1011 Ext: 1011
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2021
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