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WALGREEN CO.
CHC28965-00 FORDLAND CLINIC
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Covered Entity Details
Entity Name
FORDLAND CLINIC
Subdivision Name
Fordland Clinic
Type
HRSA-Funded Health Center
340B ID
CHC28965-00
Entity Address
1059 BARTON DR
FORDLAND, MO 65652-7350
Grant Number
H80CS28965
Participating Start Date
4/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
AVA DRUG #15726, POWERED BY WALGREENS
124 W WASHINGTON AVE
P.O. BOX 457
AVA, MO 65608
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Joan Twiton, Exec. Director
(417) 767-2273 Ext: 2022
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2021
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