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WALGREEN CO.
CHC24133-00 MAPLE CITY HEALTH CARE CENTER, INC.
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Covered Entity Details
Entity Name
MAPLE CITY HEALTH CARE CENTER, INC.
Subdivision Name
Maple City Health Care Center
Type
HRSA-Funded Health Center
340B ID
CHC24133-00
Entity Address
213 Middlebury Street
Goshen, IN 46528-2956
Grant Number
H80CS24133
Participating Start Date
4/1/2013
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 11623
102 E HIVELY AVE
ELKHART, IN 46517
Pharmacy Comments
Contract Details
Approval Date
1/9/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James N. Gingerich, Guardian of Vision
(574) 534-3300
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/9/2015
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