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WALGREEN CO.
HV616561A University of IL College of Medicine Peoria
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Covered Entity Details
Entity Name
University of IL College of Medicine Peoria
Subdivision Name
Positive Health Solutions
Type
Ryan White Part C
340B ID
HV616561A
Entity Address
2205 E. Empire
Suite A
Bloomington, IL 61704
Grant Number
H76HA00519
Participating Start Date
1/1/2019
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS PHARMACY AT CRUSADERS #21287
1200 W STATE ST STE 102
ROCKFORD, IL 61102-2112
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joanna Groden, Vice Chancellor for Research
(312) 996-2862
Contract Pharmacy Representative
Walgreens
Gustavo Hernandez, Analyst
(847) 315-1186
Signed By Date
1/12/2024
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