Contract Pharmacy Details

WALGREEN CO.
FP601851 ACCESS COMMUNITY HEALTH NETWORK

Covered Entity Details

Entity Name

ACCESS COMMUNITY HEALTH NETWORK

Subdivision Name

ACCESS West Chicago Family Health Center

Type

Family Planning (Title X only)

340B ID

FP601851

Entity Address

245 WEST ROOSEVELT ROAD
BLDG 14 SUITE 150
WEST CHICAGO, IL 60185

Grant Number

FPHPA056139

Participating Start Date

1/1/2010

Last Recertification Date

5/30/2019

Entity Termination Date

1/1/2020

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07876
7544 S STONY ISLAND AVE
CHICAGO, IL 60649-3926

Pharmacy Comments

Corrected zipcode

Contract Details

Approval Date

9/16/2010

Contract Begin Date

9/17/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/19/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

DONNA THOMPSON, CEO
(312) 526-2051

Contract Pharmacy Representative

KERMIT R. CRAWFORD, EXECUTIVE VICE PRESIDENT OF PHARMACY
(847) 315-3154

Signed By Date

8/23/2010

340B Drug Pricing Program Database