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WALGREEN CO.
CH0617170 FOURTH WARD CLINIC
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Covered Entity Details
Entity Name
FOURTH WARD CLINIC
Subdivision Name
Fourth Ward Clinic, Inc. d.b.a. GOOD NEIGHBOR HEALTHCARE CENTER
Type
HRSA-Funded Health Center
340B ID
CH0617170
Entity Address
190 HEIGHTS BLVD
HOUSTON, TX 77007-3729
Grant Number
H80CS06445
Participating Start Date
11/21/2005
Last Recertification Date
2/10/2017
Entity Termination Date
10/1/2017
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 12069
2221 FULTON STREET
HOUSTON, TX 77009-8132
Pharmacy Comments
Contract Details
Approval Date
10/7/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
Contacts
Covered Entity Signing Official
Mary Rae, CMO
(713) 387-7107
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/7/2015
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