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WALGREEN CO.
CH057580 University of Illinois
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Covered Entity Details
Entity Name
University of Illinois
Subdivision Name
University of Illinois Mile Square Health Center - IMD
Type
HRSA-Funded Health Center
340B ID
CH057580
Entity Address
1220 S. Wood Street
Chicago, IL 60608
Grant Number
H80CS00324
Participating Start Date
1/1/2000
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 00162
1554 E 55TH ST
CHICAGO, IL 60615
Pharmacy Comments
Contract Details
Approval Date
1/10/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Moss, Associate Vice Chancellor, Budget & Financial Analysis
(312) 996-0306
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/10/2023
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