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WALGREEN CO.
CH05306BD Sixteenth Street Community Health Centers, Inc.
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Covered Entity Details
Entity Name
Sixteenth Street Community Health Centers, Inc.
Subdivision Name
Sixteenth Street Community Health Centers - Carmen Schools-South High School
Type
HRSA-Funded Health Center
340B ID
CH05306BD
Entity Address
1712 S 32nd St Rm 308
Milwaukee, WI 53215-2104
Grant Number
H80CS00593
Participating Start Date
1/1/2022
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07661
2410 W FOREST HOME AVE
MILWAUKEE, WI 53215-2527
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Liz Claudio, Vice President, Operations
(414) 897-5165
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2022
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