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WALGREEN CO.
CH05320D HealthNet, Inc.
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Covered Entity Details
Entity Name
HealthNet, Inc.
Subdivision Name
Martindale-Brightwood Health Center
Type
HRSA-Funded Health Center
340B ID
CH05320D
Entity Address
2855 N Keystone Ave Ste 100
Ste 100
Indianapolis, IN 46218-2790
Grant Number
H80CS00114
Participating Start Date
10/1/1996
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #10929
1650 EAST RAYMOND STREET
INDIANAPOLIS, IN 46203-4143
Pharmacy Comments
Contract Details
Approval Date
12/19/2006
Contract Begin Date
12/19/2006
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/5/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
12/19/2006
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