340B Drug Pricing Program Database
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WALGREEN CO.
CHC22690-00 MACOUPIN, COUNTY OF
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Covered Entity Details
Entity Name
MACOUPIN, COUNTY OF
Subdivision Name
Macoupin County Maple Street Clinic
Type
HRSA-Funded Health Center
340B ID
CHC22690-00
Entity Address
109 E Maple St
Gillespie, IL 62033-1473
Grant Number
H80CS22690
Participating Start Date
7/1/2012
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01996
1122 VAUGHN RD
WOOD RIVER, IL 62095
Pharmacy Comments
Contract Details
Approval Date
4/1/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kent Tarro, CEO
(217) 825-6705
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/1/2015
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