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WALGREEN CO.
CHC26568-03 SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER
Subdivision Name
Regional Health Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26568-03
Entity Address
4022 Hohman
HAMMOND, IN 46327-1242
Grant Number
H80CS26568
Participating Start Date
7/1/2016
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13949
6001 CENTRAL AVE
PORTAGE, IN 46368-3506
Pharmacy Comments
09/27/2012 Pharmacy moved (was #2765 6030 CENTRAL)
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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