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WALGREEN CO.
CH052760 CRUSADERS CENTRAL CLINIC ASSOCIATION
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Covered Entity Details
Entity Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Clinic on West State Street
Type
HRSA-Funded Health Center
340B ID
CH052760
Entity Address
1200 W State St
Rockford, IL 61102-2112
Grant Number
H80CS00113
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11411
395 S. DIVISION ST.
HARVARD, IL 60033-3258
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
Samuel Miller, President/CEO
(815) 490-1600
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2021
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