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WALGREEN CO.
CH052090 MILWAUKEE HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
MILWAUKEE HEALTH SERVICES, INC.
Subdivision Name
MILWAUKEE HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH052090
Entity Address
2555 N Dr Martin Luther King Dr
Milwaukee, WI 53212-2709
Grant Number
H80CS00826
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10196
6600 WEST STATE STREET
WAUWATOSA, WI 53213
Pharmacy Comments
Contract Details
Approval Date
10/6/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tito Izard, President/CEO
(414) 267-2021
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/6/2015
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