Contract Pharmacy Details

WALGREEN CO.
CH05103B TCA HEALTH, INC. NFP

Covered Entity Details

Entity Name

TCA HEALTH, INC. NFP

Subdivision Name

Mobile Student Health Clinic, Parking Lot B

Type

HRSA-Funded Health Center

340B ID

CH05103B

Entity Address

1029 East 130th St., Pkg Lot B
Chicago, IL 60628-6062

Grant Number

H80CS00109

Participating Start Date

4/1/2020

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06629
8701 S CICERO AVE
HOMETOWN, IL 60456-1018

Pharmacy Comments

Contract Details

Approval Date

1/14/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

VERONICA CLARKE, CEO
(773) 995-6300 Ext: 213

Contract Pharmacy Representative

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

Signed By Date

1/14/2022

340B Drug Pricing Program Database