Contract Pharmacy Details

WALGREEN CO.
FQHC638398 JAMESTOWN S'KLALLAM TRIBE

Covered Entity Details

Entity Name

JAMESTOWN S'KLALLAM TRIBE

Subdivision Name

Jamestown Family Health Clinic

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638398

Entity Address

808 N. 5th Avenue
SEQUIM, WA 98382

Grant Number

Participating Start Date

1/1/2001

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16403
1409 11TH AVE.
SEATTLE, WA 98122

Pharmacy Comments

Contract Details

Approval Date

4/13/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Brent D. Simcosky, Director of Health Services
(360) 582-4870

Contract Pharmacy Representative

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

Signed By Date

4/13/2022

340B Drug Pricing Program Database