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WALGREEN CO.
RWI46201 Damien Center
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Covered Entity Details
Entity Name
Damien Center
Subdivision Name
Type
Ryan White Part A
340B ID
RWI46201
Entity Address
26 N. Arsenal Ave
Indianapolis, IN 46201
Grant Number
H89HA11463
Participating Start Date
4/1/2013
Last Recertification Date
2/9/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03194
9050 E. 38TH STREET
INDIANAPOLIS, IN 46235
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/14/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas Bartenbach, Executive Director
(317) 632-0123 Ext: 266
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2013
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