Contract Pharmacy Details

WALGREEN CO.
RWIID627618 ILLINOIS DEPARTMENT OF PUBLIC HEALTH

Covered Entity Details

Entity Name

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

Subdivision Name

HIV/AIDS/ADAP SECTION

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID627618

Entity Address

535 West Jefferson Street
SPRINGFIELD, IL 62702-5076

Grant Number

5 X07HA00013-35-00

Participating Start Date

4/1/1997

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05192
9148 S COMMERCIAL AVE
CHICAGO, IL 60617

Pharmacy Comments

Contract Details

Approval Date

4/14/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/20/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Jeffrey Maras, HIV/AIDS SECTION, ADAP
(217) 524-5983

Contract Pharmacy Representative

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

Signed By Date

4/14/2022

340B Drug Pricing Program Database