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WALGREEN CO.
TB55415 Hennepin County
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Covered Entity Details
Entity Name
Hennepin County
Subdivision Name
Hennepin County Public Health Clinic
Type
Tuberculosis
340B ID
TB55415
Entity Address
525 Portland Avenue
MC 952
Minneapolis, MN 55415
Grant Number
1NU52PS910308
Participating Start Date
4/1/2013
Last Recertification Date
5/17/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09795
1585 RANDOLPH AVE
ST PAUL, MN 55105-2149
Pharmacy Comments
Contract Details
Approval Date
7/3/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary Jo LaCroix Meuleners, Clinic Manager
(612) 348-3283
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/3/2023
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