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WALGREEN CO.
CH057440 PCC COMMUNITY WELLNESS CENTER
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Covered Entity Details
Entity Name
PCC COMMUNITY WELLNESS CENTER
Subdivision Name
PCC Lake Street Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH057440
Entity Address
14 Lake St
Oak Park, IL 60302-2606
Grant Number
H80CS00276
Participating Start Date
7/1/1997
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15506
3303 W. 26TH STREET
SUITE 101
CHICAGO, IL 60623
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
Robert Urso, President & CEO
(708) 524-7686
Contract Pharmacy Representative
Walgreens
Gustavo Hernandez, Analyst
(847) 315-1186
Signed By Date
1/16/2024
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