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WALGREEN CO.
CHC10591-00 COMMUNITY CLINIC, INC.
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Covered Entity Details
Entity Name
COMMUNITY CLINIC, INC.
Subdivision Name
CCI-Takoma Park
Type
HRSA-Funded Health Center
340B ID
CHC10591-00
Entity Address
7676 NEW HAMPSHIRE AVENUE
Suite 200
TAKOMA PARK, MD 20912
Grant Number
H80CS10591
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17803
9139 RIGGS RD
ADELPHI, MD 20783
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/29/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Sonya J. Bruton, CEO and President
(240) 839-5107
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2022
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