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WALGREEN CO.
CH030130 PARK WEST HEALTH SYSTEMS INCORPORATED
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Covered Entity Details
Entity Name
PARK WEST HEALTH SYSTEMS INCORPORATED
Subdivision Name
PARK WEST MEDICAL CENTER - BELVEDERE
Type
HRSA-Funded Health Center
340B ID
CH030130
Entity Address
3319 W Belvedere Ave
Baltimore, MD 21215-5143
Grant Number
H80CS00067
Participating Start Date
12/1/1992
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06265
9110 LIBERTY ROAD
RANDALLSTOWN, MD 21133
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALLEN J. BENNETT, PRESIDENT & CEO
(410) 542-7800 Ext: 7501
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2025
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