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WALGREEN CO.
CHC26568-02 SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER
Subdivision Name
Southlake Community Mental Health Center, Inc., d.b.a. Regional Health Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26568-02
Entity Address
3903 Indianapolis Blvd
East Chicago, IN 46312-2555
Grant Number
H80CS26568
Participating Start Date
1/1/2016
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12788
407 W. GLEN PARK AVENUE
GRIFFITH, IN 46319
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
Amy Lopez, Executive Director
(219) 671-6047
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2023
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