Contract Pharmacy Details

WALGREEN EASTERN CO. INC.
FQHCLA297 URBAN HEALTH INITIATIVES, INC.

Covered Entity Details

Entity Name

URBAN HEALTH INITIATIVES, INC.

Subdivision Name

Urban Health Initiatives

Type

Health Center Program Look-Alike

340B ID

FQHCLA297

Entity Address

1408 S. Broad Street
Philadelphia, PA 19146

Grant Number

LALCS00130

Participating Start Date

7/1/2012

Last Recertification Date

3/3/2015

Entity Termination Date

7/1/2015

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO. INC.

Pharmacy Address

DBA:WALGREENS #15336
1 SOUTH BROAD STREET
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

1/10/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2015

Contacts

Covered Entity Signing Official

Kobie T. West, CEO
(215) 755-0700 Ext: 132

Contract Pharmacy Representative

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

Signed By Date

1/10/2014

340B Drug Pricing Program Database