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WALGREEN CO.
FP60108 ACCESS COMMUNITY HEALTH NETWORK
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Covered Entity Details
Entity Name
ACCESS COMMUNITY HEALTH NETWORK
Subdivision Name
ACCESS Martin T. Russo Family Health Center
Type
Family Planning (Title X only)
340B ID
FP60108
Entity Address
245 SOUTH GARY AVENUE
LOWER LEVEL
BLOOMINGDALE, IL 60108
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 # 06376
8636 S ASHLAND AVE
CHICAGO, IL 60620-4829
Pharmacy Comments
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
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