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WALGREEN CO.
CH0537520 COVENANT COMMUNITY CARE, INC.
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Covered Entity Details
Entity Name
COVENANT COMMUNITY CARE, INC.
Subdivision Name
Covenant Michigan Avenue Clinic
Type
HRSA-Funded Health Center
340B ID
CH0537520
Entity Address
5716 Michigan Ave
Detroit, MI 48210-3039
Grant Number
H80CS08738
Participating Start Date
10/1/2007
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04369
19800 PLYMOUTH RD.
DETROIT, MI 48228
Pharmacy Comments
Contract Details
Approval Date
1/8/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/28/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Propson, CEO
(313) 228-0216
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2015
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