Contract Pharmacy Details

WALGREEN CO.
CH051741H SHALOM HEALTH CARE CENTER, INC.

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 # 05264
6269 W 38TH ST
INDIANAPOLIS, IN 46254

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

7/29/2016
Pharmacy closed

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

340B Drug Pricing Program Database