340B Drug Pricing Program Database
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WALGREEN CO.
RWI63139 Southampton Community Healthcare, Inc
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Covered Entity Details
Entity Name
Southampton Community Healthcare, Inc
Subdivision Name
Type
Ryan White Part A
340B ID
RWI63139
Entity Address
2340 Hampton Ave
Saint Louis, MO 63139
Grant Number
H89HA00033
Participating Start Date
1/1/2023
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #16326
2315 S KINGSHIGHWAY BLVD
SAINT LOUIS, MO 63110
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David James Prelutsky, President
(314) 276-3090
Contract Pharmacy Representative
Walgreens
Eric Ambroz, 340B Client Relationship Analyst
(847) 315-5357
Signed By Date
4/11/2023
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