Contract Pharmacy Details

WALGREEN CO.
CH05320Q HealthNet, Inc.

Covered Entity Details

Entity Name

HealthNet, Inc.

Subdivision Name

Holy Family Shelter

Type

HRSA-Funded Health Center

340B ID

CH05320Q

Entity Address

907 N Holmes Ave
Indianapolis, IN 46222-3714

Grant Number

H80CS00114

Participating Start Date

4/1/2014

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03142
3455 MANN ROAD
INDIANAPOLIS, IN 46221

Pharmacy Comments

Contract Details

Approval Date

10/13/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

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

340B Drug Pricing Program Database