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WALGREEN CO.
CH034180 SOUTHERN DOMINION HEALTH SYSTEMS, INC.
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Covered Entity Details
Entity Name
SOUTHERN DOMINION HEALTH SYSTEMS, INC.
Subdivision Name
ADMINISTRATIVE OFFICE
Type
HRSA-Funded Health Center
340B ID
CH034180
Entity Address
1508 K-V ROAD
VICTORIA, VA 23974
Grant Number
H80CS00173
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09226
4238 W HUNDRED RD
CHESTER, VA 23831-1733
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jill Seamans, CFO
(434) 696-2165
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2021
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