Contract Pharmacy Details

WALGREEN CO.
CHC26514-00 TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Covered Entity Details

Entity Name

TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Subdivision Name

TAPM Pediatrics at Wendover

Type

HRSA-Funded Health Center

340B ID

CHC26514-00

Entity Address

1046 E Wendover Ave
Greensboro, NC 27405-6712

Grant Number

H80CS26514

Participating Start Date

1/1/2015

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #16129
407 W MAIN ST
JAMESTOWN, NC 27282

Pharmacy Comments

Contract Details

Approval Date

10/13/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michelle Lewis, CEO
(336) 355-9715

Contract Pharmacy Representative

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

Signed By Date

10/13/2021

340B Drug Pricing Program Database