Contract Pharmacy Details

Walgreens Central Fill #21400
CH012010 MATTAPAN COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

MATTAPAN COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Mattapan Community Health Center

Type

HRSA-Funded Health Center

340B ID

CH012010

Entity Address

1575 Blue Hill Ave
Mattapan, MA 02126-2122

Grant Number

H80CS00395

Participating Start Date

7/1/2002

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

Walgreens Central Fill #21400

Pharmacy Address

44 Cabot Blvd.
Mansfield, MA 02048

Pharmacy Comments

Contract Details

Approval Date

1/5/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

GUALE VALDEZ, CEO
(617) 898-9020

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/5/2023

340B Drug Pricing Program Database