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WALGREEN CO.
FQHCLA480A Crossover Health Services, Inc.
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Covered Entity Details
Entity Name
Crossover Health Services, Inc.
Subdivision Name
Crossover Health Services at 36th Street
Type
Health Center Program Look-Alike
340B ID
FQHCLA480A
Entity Address
940 E 36th St N
Tulsa, OK 74106-1953
Grant Number
LALCS54597
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #16026
717 S HOUSTON AVE, STE 103
TULSA, OK 74127
Pharmacy Comments
Contract Details
Approval Date
4/1/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Whitaker, CEO
(918) 724-9020
Contract Pharmacy Representative
Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116
Signed By Date
4/1/2025
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