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WALGREEN CO
CH078000 GREAT MINES HEALTH CENTER
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Covered Entity Details
Entity Name
GREAT MINES HEALTH CENTER
Subdivision Name
Great Mines Health Center
Type
HRSA-Funded Health Center
340B ID
CH078000
Entity Address
#1 Southtowne Dr.
Potosi, MO 63664
Grant Number
H80CS06670
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10540
12977 STATE ROUTE 21
DE SOTO, MO 63020-1078
Pharmacy Comments
Contract Details
Approval Date
8/31/2012
Contract Begin Date
8/31/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Johnson, CEO
(573) 438-9355 Ext: 8320
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
8/29/2012
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