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Walgreens #21420
CHC26514-00 TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
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Covered Entity Details
Entity Name
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Subdivision Name
TAPM Pediatrics at Wendover
Type
HRSA-Funded Health Center
340B ID
CHC26514-00
Entity Address
1046 E Wendover Ave
Greensboro, NC 27405-6712
Grant Number
H80CS26514
Participating Start Date
1/1/2015
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
Walgreens #21420
Pharmacy Address
Walgreens Central Fill #21420
8440 Times Dispatch Blvd
Ste. 400
Mechanicsville, VA 23116
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michelle Lewis, CEO
(336) 355-9715
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2023
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