Contract Pharmacy Details

WALGREEN CO.
FQHCLA211 HEALTH CENTERS DETROIT MEDICAL GROUP

Covered Entity Details

Entity Name

HEALTH CENTERS DETROIT MEDICAL GROUP

Subdivision Name

ADMINISTRATIVE

Type

Health Center Program Look-Alike

340B ID

FQHCLA211

Entity Address

4201 ST ANTOINE BLVD, 9D
DETROIT, MI 48201-2153

Grant Number

LALCS00008

Participating Start Date

1/1/2007

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05226
14048 WOODWARD AVE
HIGHLAND PARK, MI 48203

Pharmacy Comments

Contract Details

Approval Date

4/16/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/21/2017
Pharmacy closed

Contacts

Covered Entity Signing Official

HERBERT C. SMITHERMAN, PRESIDENT AND CEO
(313) 966-5187

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/16/2013

340B Drug Pricing Program Database