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WALGREEN CO.
CH0814640 CHEYENNE HEALTH AND WELLNESS CENTER
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Covered Entity Details
Entity Name
CHEYENNE HEALTH AND WELLNESS CENTER
Subdivision Name
CHEYENNE HEALTH AND WELLNESS CENTER
Type
HRSA-Funded Health Center
340B ID
CH0814640
Entity Address
2508 EAST FOX FARM ROAD STE 1-1A
CHEYENNE, WY 82007
Grant Number
H80CS04196
Participating Start Date
7/1/2005
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21454
4745 ARAPAHOE AVE STE 140
BOULDER, CO 80303
Pharmacy Comments
Contract Details
Approval Date
4/14/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David W. Squires, CEO
(307) 635-3618 Ext: 1070
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2016
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