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WALGREEN CO.
FQHCLA402 Good Samaritan Family Health Center Inc.
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Covered Entity Details
Entity Name
Good Samaritan Family Health Center Inc.
Subdivision Name
Family Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA402
Entity Address
1027 Washington Avenue
Suite B
Vincennes, IN 47591
Grant Number
LALCS33817
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11882
1915 W BROADWAY STREET
PRINCETON, IN 47670
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Emmons, CEO
(812) 494-7800
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2024
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