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WALGREEN CO.
CHC08752-00 LAKELAND IMMEDIATE CARE CENTER
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Covered Entity Details
Entity Name
LAKELAND IMMEDIATE CARE CENTER
Subdivision Name
DBA CASS FAMILY CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC08752-00
Entity Address
261 M-62
Cassopolis, MI 49031-1034
Grant Number
H80CS08752
Participating Start Date
4/1/2010
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06965
15005 STATE ROAD 23
GRANGER, IN 46530-9666
Pharmacy Comments
Contract Details
Approval Date
10/15/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARY GEEGAN MIDDLETON, Chief Executive Officer
(269) 445-3874 Ext: 109
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2013
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