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WALGREEN CO.
CH05662J ALIVIO MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
ALIVIO MEDICAL CENTER, INC
Subdivision Name
Benito Juarez Community Academy
Type
HRSA-Funded Health Center
340B ID
CH05662J
Entity Address
1450 W Cermak Rd
Chicago, IL 60608-4408
Grant Number
H80CS00116
Participating Start Date
7/1/2015
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05926
4385 S ARCHER AVE
CHICAGO, IL 60632
Pharmacy Comments
Contract Details
Approval Date
4/16/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ESTHER CORPUZ, CHIEF EXECUTIVE OFFICER
(312) 829-6304
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2024
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