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WALGREEN CO.
CHC07502-00 Legacy Community Health Services, Inc.
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Covered Entity Details
Entity Name
Legacy Community Health Services, Inc.
Subdivision Name
Legacy Montrose Clinic
Type
HRSA-Funded Health Center
340B ID
CHC07502-00
Entity Address
1415 California St
Houston, TX 77006-2602
Grant Number
H80CS07502
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07178
100 FM 646 ROAD NORTH
DICKINSON, TX 77539-3023
Pharmacy Comments
01/24/2012 updated address line 1 (added Road West)
Contract Details
Approval Date
7/9/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/19/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Katy Caldwell, Executive Director
(832) 548-5050
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/9/2013
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