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WALGREEN CO.
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Jane Pauley Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26566-00
Entity Address
8931 E. 30th Street
Indianapolis, IN 46219-1501
Grant Number
H80CS26566
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13874
985 N. ARLINGTON AVE
INDIANAPOLIS, IN 46219
Pharmacy Comments
02/13/2013 phamracy moved (was Walgreens # 2799 5460 E. WASHINGTON STREET)
Contract Details
Approval Date
3/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Dale, Finanace Directror
(317) 355-8704
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2014
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