Contract Pharmacy Details

WALGREEN CO.
CH052760 CRUSADERS CENTRAL CLINIC ASSOCIATION

Covered Entity Details

Entity Name

CRUSADERS CENTRAL CLINIC ASSOCIATION

Subdivision Name

Crusader Clinic on West State Street

Type

HRSA-Funded Health Center

340B ID

CH052760

Entity Address

1200 W State St
Rockford, IL 61102-2112

Grant Number

H80CS00113

Participating Start Date

12/1/1992

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS PHARMACY AT CRUSADERS #21287
1200 W STATE ST STE 102
ROCKFORD, IL 61102-2112

Pharmacy Comments

Contract Details

Approval Date

4/14/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

GORDON EGGERS JR., CEO
(815) 490-1616

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/14/2016

340B Drug Pricing Program Database