Contract Pharmacy Details

WALGREEN CO.
CH05662F ALIVIO MEDICAL CENTER, INC

Covered Entity Details

Entity Name

ALIVIO MEDICAL CENTER, INC

Subdivision Name

Jose Clemente Orozco Academy

Type

HRSA-Funded Health Center

340B ID

CH05662F

Entity Address

1940 W 18th St
Chicago, IL 60608-1903

Grant Number

H80CS00116

Participating Start Date

7/1/2013

Last Recertification Date

2/26/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06641
1614 W 47TH STREET
CHICAGO, IL 60609-3245

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

340B Drug Pricing Program Database