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WALGREEN CO.
FP60617 AUNT MARTHA'S COMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
AUNT MARTHA'S COMUNITY HEALTH CENTER
Subdivision Name
AUNT MARTHA'S SOUTHEAST SIDE COMUNITY HEALTH CENTER
Type
Family Planning (Title X only)
340B ID
FP60617
Entity Address
3528 E. 118TH ST
CHICAGO, IL 60617
Grant Number
FPHPA006459
Participating Start Date
4/1/2020
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09357
833 W 115TH ST
CHICAGO, IL 60643-4619
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Audrey Pennington, Chief Operating Officer
(708) 747-7100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/17/2017
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