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WALGREEN CO.
CH040650 PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Park DuValle Community Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH040650
Entity Address
3015 Wilson Ave
Louisville, KY 40211-1969
Grant Number
H80CS00083
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05449
3600 FERN VALLEY RD
LOUISVILLE, KY 40219
Pharmacy Comments
Contract Details
Approval Date
1/31/2012
Contract Begin Date
1/31/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Anthony Omojasola, CEO
(502) 772-5027
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/13/2012
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