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Walgreens MFC #21373
CH06018Q TECHE ACTION BOARD
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Covered Entity Details
Entity Name
TECHE ACTION BOARD
Subdivision Name
Teche Action Clinic @ Gramercy
Type
HRSA-Funded Health Center
340B ID
CH06018Q
Entity Address
827 N Pine St
Gramercy, LA 70052-3602
Grant Number
H80CS00767
Participating Start Date
1/1/2024
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
Walgreens MFC #21373
Pharmacy Address
4100 Dale Earnhardt Way
200
Northlake, TX 76262
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
Nikina Vilcan, CFO
(337) 828-2550 Ext: 2146
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2024
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