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WALGREEN CO.
CH07731H Community Health Centers Of Southeastern Iowa, Inc
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Covered Entity Details
Entity Name
Community Health Centers Of Southeastern Iowa, Inc
Subdivision Name
CHC/SEIA Burlington Pediatric Clinic
Type
HRSA-Funded Health Center
340B ID
CH07731H
Entity Address
1223 S Gear Ave Ste 108
West Burlington, IA 52655-1685
Grant Number
H80CS00272
Participating Start Date
4/1/2021
Last Recertification Date
2/9/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05044
3245 AGENCY STREET
BURLINGTON, IA 52601
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Antonio Flores, CEO
(319) 753-2300 Ext: 122
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2024
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