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WALGREEN CO.
CHC00341-00 PRIMECARE COMMUNITY HEALTH INC
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Covered Entity Details
Entity Name
PRIMECARE COMMUNITY HEALTH INC
Subdivision Name
PRIMECARE WEST TOWN
Type
HRSA-Funded Health Center
340B ID
CHC00341-00
Entity Address
1431 N Western Ave
Ste 406
Chicago, IL 60622
Grant Number
H80CS00341
Participating Start Date
4/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS #15971
259 E. ERIE STREET
SUITE 250
CHICAGO, IL 60611
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael C Holtrop, Chief Financial Officer
(616) 482-9892
Contract Pharmacy Representative
Walgreens
Aliena Jaffri, 340b Client Relationship Analyst
(847) 964-6103
Signed By Date
7/14/2022
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