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WALGREEN CO.
CH051741H SHALOM HEALTH CARE CENTER, INC.
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Covered Entity Details
Entity Name
SHALOM HEALTH CARE CENTER, INC.
Subdivision Name
SHALOM PRIMARY CARE CENTER
Type
HRSA-Funded Health Center
340B ID
CH051741H
Entity Address
3400 Lafayette Rd
Indianapolis, IN 46222-1146
Grant Number
H80CS00880
Participating Start Date
7/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02796
3003 KESSLER BLVD NORTH DR
INDIANAPOLIS, IN 46222
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Leonardo R. Ortega, EXECUTIVE DIRECTOR/CEO
(317) 291-7422 Ext: 1203
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2013
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