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WALGREEN CO.
CHC00341-03 PRIMECARE COMMUNITY HEALTH INC
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Covered Entity Details
Entity Name
PRIMECARE COMMUNITY HEALTH INC
Subdivision Name
PrimeCare Northwest
Type
HRSA-Funded Health Center
340B ID
CHC00341-03
Entity Address
1649 N Pulaski Rd
Chicago, IL 60639
Grant Number
H80CS00341
Participating Start Date
7/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09470
4817 W FULLERTON AVE
CHICAGO, IL 60639-2503
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael C Holtrop, Chief Financial Officer
(616) 482-9892
Contract Pharmacy Representative
Walgreens
Aliena Jaffri, 340b Client Relationship Analyst
(847) 964-6103
Signed By Date
4/15/2024
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