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WALGREEN CO
CHC26633-00 Owensville Primary Care, Inc.
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Covered Entity Details
Entity Name
Owensville Primary Care, Inc.
Subdivision Name
OPC Shady Side V1
Type
HRSA-Funded Health Center
340B ID
CHC26633-00
Entity Address
6131 Shady Side Rd
Shady Side, MD 20764-9504
Grant Number
H80CS26633
Participating Start Date
10/1/2022
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #09632
2970 SHASHO PLACE
WALDORF, MD 20603
Pharmacy Comments
Contract Details
Approval Date
5/2/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Juanita M Tryon, Chief Executive Officer
(443) 607-1438
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
5/2/2023
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