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WALGREEN CO.
CH057260D KENOSHA COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Kenosha Community Health Center Mobile Medical Unit
Type
HRSA-Funded Health Center
340B ID
CH057260D
Entity Address
6226 14th Ave
Kenosha, WI 53143-4413
Grant Number
H80CS00662
Participating Start Date
4/1/2023
Last Recertification Date
2/15/2024
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #15433
600 TRES PINOS RD
HOLLISTER, CA 95023
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/13/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Gary Moss, Chief Financial Officer
(262) 764-3619
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2023
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