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WALGREEN CO
HV00140 Southwest Boulevard Family Health Care
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Covered Entity Details
Entity Name
Southwest Boulevard Family Health Care
Subdivision Name
Type
Ryan White Part C
340B ID
HV00140
Entity Address
340 Southwest Boulevard
Kansas City, KS 66103
Grant Number
H76HA00140
Participating Start Date
1/1/2013
Last Recertification Date
2/25/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10125
2850 STATE AVENUE
KANSAS CITY, KS 66102
Pharmacy Comments
Contract Details
Approval Date
1/8/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kevin Dennis, Program Administrator
(913) 722-3100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2016
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