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WALGREEN CO.
CHC24098-17 SOUTHERN ILLINOIS UNIVERSITY
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine-GIM Salvation Army
Type
HRSA-Funded Health Center
340B ID
CHC24098-17
Entity Address
1600 E Clear Lake Ave Ste 120
Springfield, IL 62703-1172
Grant Number
H80CS24098
Participating Start Date
4/1/2022
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05719
4995 E US ROUTE 36
DECATUR, IL 62521
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Iris Elenora Wesley, CEO
(217) 757-8116
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2025
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