Contract Pharmacy Details

WALGREEN CO
CHC22690-05 MACOUPIN, COUNTY OF

Covered Entity Details

Entity Name

MACOUPIN, COUNTY OF

Subdivision Name

Oakland Avenue Clinic

Type

HRSA-Funded Health Center

340B ID

CHC22690-05

Entity Address

205 Oakland Ave
Carlinville, IL 62626-1921

Grant Number

H80CS22690

Participating Start Date

7/1/2023

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #10718
1202 W UNION AVE
LITCHFIELD, IL 62056

Pharmacy Comments

Contract Details

Approval Date

7/15/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lori J Sanson, CFO
(217) 930-2282

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/15/2024

340B Drug Pricing Program Database