Contract Pharmacy Details

WALGREEN CO.
RWI28215 EASTOWNE FAMILY PHYSICIANS, PA

Covered Entity Details

Entity Name

EASTOWNE FAMILY PHYSICIANS, PA

Subdivision Name

Type

Ryan White Part A

340B ID

RWI28215

Entity Address

4115 The Plaza
CHARLOTTE, NC 28205

Grant Number

CHARLOTTE TGA

Participating Start Date

7/1/2010

Last Recertification Date

2/7/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11692
500 FINCHER ST.
MONROE, NC 28112

Pharmacy Comments

Contract Details

Approval Date

11/25/2011

Contract Begin Date

11/25/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tagbo Ekwonu, Medical Director
(704) 532-4567

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

11/4/2011

340B Drug Pricing Program Database