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WALGREEN CO.
CH11355-00 FIRST CARE CLINIC, INC.
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Covered Entity Details
Entity Name
FIRST CARE CLINIC, INC.
Subdivision Name
First Care Clinic, Inc.
Type
HRSA-Funded Health Center
340B ID
CH11355-00
Entity Address
105 W. 13th Street
Hays, KS 67601
Grant Number
H80CS12891
Participating Start Date
10/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16517
803 N BROADWAY AVE
WICHITA, KS 67214
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric C Flax, CEO
(785) 621-4990
Contract Pharmacy Representative
Walgreens
Edwin Raff, DVP Contracting & Pricing
(847) 964-6198
Signed By Date
4/14/2023
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