Contract Pharmacy Details

WALGREEN CO.
STD53212 Holton Street Clinic, Inc

Covered Entity Details

Entity Name

Holton Street Clinic, Inc

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD53212

Entity Address

3251 N. HOLTON ST.
MILWAUKEE, WI 53212-2126

Grant Number

1U52PS005148

Participating Start Date

1/1/2008

Last Recertification Date

5/8/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04095
10800 W. CAPITOL
WAUWATOSA, WI 53222

Pharmacy Comments

Contract Details

Approval Date

1/16/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David Wenten, Executive Director
(414) 264-8800

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/16/2024

340B Drug Pricing Program Database