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Walgreens Central Fill #21394
CH07440A DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
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Covered Entity Details
Entity Name
DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Subdivision Name
DOUGLAS COUNTY PUBLIC HEALTH
Type
HRSA-Funded Health Center
340B ID
CH07440A
Entity Address
504 W. Broadway Ave.
AVA, MO 65608-1359
Grant Number
H80CS00457
Participating Start Date
4/1/2004
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
Walgreens Central Fill #21394
Pharmacy Address
2601 Hughes Road
Suite 103
Liberty, MO 64068
Pharmacy Comments
Contract Details
Approval Date
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim R Shryack, CEO
(417) 683-4831 Ext: 110
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2023
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