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WALGREEN CO.
CH056960 SOUTHSIDE COMMUNITY HEALTH SERVICES
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Covered Entity Details
Entity Name
SOUTHSIDE COMMUNITY HEALTH SERVICES
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH056960
Entity Address
4243 4TH AVE SOUTH
MINNEAPOLIS, MN 55409
Grant Number
H80CS00198
Participating Start Date
10/1/1996
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 00828
12 W 66TH ST
RICHFIELD, MN 55423
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Cazaban, Executive Director
(612) 821-2025
Contract Pharmacy Representative
Southside Community Health Services
Ann Cazaban, Executive Director
(612) 821-2025
Signed By Date
1/16/2023
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