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WALGREEN CO.
HV00133 JEFFERSON COMPREHENSIVE CARE SYSTEM INC
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Covered Entity Details
Entity Name
JEFFERSON COMPREHENSIVE CARE SYSTEM INC
Subdivision Name
PINE BLUFF MEDICAL & DENTAL CENTER
Type
Ryan White Part C
340B ID
HV00133
Entity Address
1101 S TENNESSEE STREET
PINE BLUFF, AR 71601
Grant Number
H76HA00133
Participating Start Date
1/1/2007
Last Recertification Date
3/7/2025
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #21551
5805 DOLLARWAY RD STE B
WHITE HALL, AR 71602
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sandra J. Brown, Chief Executive Officer
(870) 543-2300
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2023
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