Contract Pharmacy Details

WALGREEN CO.
CHC08772-00 GRACEMED HEALTH CLINIC, INC.

Covered Entity Details

Entity Name

GRACEMED HEALTH CLINIC, INC.

Subdivision Name

GraceMed Main Health Clinic

Type

HRSA-Funded Health Center

340B ID

CHC08772-00

Entity Address

1122 N Topeka St
Wichita, KS 67214-2810

Grant Number

H80CS08772

Participating Start Date

4/1/2005

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07147
1555 S BROADWAY AVE
WICHITA, KS 67211-3131

Pharmacy Comments

Contract Details

Approval Date

3/15/2012

Contract Begin Date

3/15/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/24/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

DAVID C. SANFORD, CEO
(316) 494-2001

Contract Pharmacy Representative

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

Signed By Date

3/13/2012

340B Drug Pricing Program Database