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WALGREEN CO.
CH05320Z HealthNet, Inc.
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Covered Entity Details
Entity Name
HealthNet, Inc.
Subdivision Name
Avondale Meadows Academy School-Based Health Center
Type
HRSA-Funded Health Center
340B ID
CH05320Z
Entity Address
3980 Meadows Dr
Indianapolis, IN 46205-3114
Grant Number
H80CS00114
Participating Start Date
1/1/2016
Last Recertification Date
2/3/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #21381
2920 E 38TH ST
INDIANAPOLIS, IN 46218
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
1/1/2025
Covered Entity Terminated
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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