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WALGREEN CO.
CH05320AH HealthNet, Inc.
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Covered Entity Details
Entity Name
HealthNet, Inc.
Subdivision Name
Crispus Attucks Clinic
Type
HRSA-Funded Health Center
340B ID
CH05320AH
Entity Address
1140 Dr Martin Luther King Jr St
Rm 615
Indianapolis, IN 46202-2221
Grant Number
H80CS00114
Participating Start Date
1/1/2022
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03609
5095 E. THOMPSON RD.
INDIANAPOLIS, IN 46237
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/20/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Varon Edward Cantrell, Chief Medical Officer
(317) 957-2015
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2023
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