Contract Pharmacy Details

WALGREEN CO
RWI30058 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER - LITHONIA

Type

Ryan White Part A

340B ID

RWI30058

Entity Address

5700 HILLANDALE DRIVE, SUITE 100
LITHONIA, GA 30058

Grant Number

H89HA00007

Participating Start Date

10/1/2013

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA; WALGREENS #12147
575 DACULA RD
DACULA, GA 30019

Pharmacy Comments

Contract Details

Approval Date

7/13/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022

Contract Pharmacy Representative

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

Signed By Date

7/13/2022

340B Drug Pricing Program Database