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WALGREEN CO.
CH05276B CRUSADERS CENTRAL CLINIC ASSOCIATION
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Covered Entity Details
Entity Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Clinic on Broadway
Type
HRSA-Funded Health Center
340B ID
CH05276B
Entity Address
1100 Broadway
Rockford, IL 61104-1429
Grant Number
H80CS00113
Participating Start Date
7/1/1997
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS PHARMACY AT CRUSADERS #21287
1200 W STATE ST STE 102
ROCKFORD, IL 61102-2112
Pharmacy Comments
Contract Details
Approval Date
7/7/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/8/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Samuel Miller, President/CEO
(815) 490-1600
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/7/2023
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