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WALGREEN CO.
CH056960 SOUTHSIDE COMMUNITY HEALTH SERVICES
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Covered Entity Details
Entity Name
SOUTHSIDE COMMUNITY HEALTH SERVICES
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH056960
Entity Address
4243 4TH AVE SOUTH
MINNEAPOLIS, MN 55409
Grant Number
H80CS00198
Participating Start Date
10/1/1996
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS SPECIALTY PHARMACY #11916
1221 W LAKE ST, STE 200
MINNEAPOLIS, MN 55408
Pharmacy Comments
Contract Details
Approval Date
4/19/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Cazaban, Executive Director
(612) 821-2025
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/19/2017
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