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WALGREEN CO.
CHC12862-00 Loudoun Community Health Center
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Covered Entity Details
Entity Name
Loudoun Community Health Center
Subdivision Name
Loudoun Community Health Center dba HealthWorks for Northern Virginia
Type
HRSA-Funded Health Center
340B ID
CHC12862-00
Entity Address
163 Fort Evans Rd NE
Leesburg, VA 20176
Grant Number
H80CS12862
Participating Start Date
1/1/2009
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10165
603 ELDEN ST.
HERNDON, VA 20170-4722
Pharmacy Comments
Contract Details
Approval Date
4/6/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carol Jameson, CEO
(703) 840-4704
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/6/2015
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