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WALGREEN CO.
CH053110 INDIANA HEALTH CENTERS INCORPORATED
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Covered Entity Details
Entity Name
INDIANA HEALTH CENTERS INCORPORATED
Subdivision Name
INDIANA HEALTH CENTERS, INC.
Type
HRSA-Funded Health Center
340B ID
CH053110
Entity Address
8003 Castleway Dr
Indianapolis, IN 46250-1946
Grant Number
H80CS00668
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09827
720 N BROADWAY
PERU, IN 46970-1027
Pharmacy Comments
Contract Details
Approval Date
7/8/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Lundy, CEO
(317) 576-1335 Ext: 4124
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/8/2013
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