Contract Pharmacy Details

WALGREEN CO
CHC22690-00 MACOUPIN, COUNTY OF

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 #10718
1202 W UNION AVE
LITCHFIELD, IL 62056

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

340B Drug Pricing Program Database