Contract Pharmacy Details

WALGREEN CO.
FP604668 AUNT MARTHA'S YOUTH SERVICE CENTER, INC.

Covered Entity Details

Entity Name

AUNT MARTHA'S YOUTH SERVICE CENTER, INC.

Subdivision Name

Type

Family Planning (Title X only)

340B ID

FP604668

Entity Address

233 WEST JOE ORR ROAD
CHICAGO HEIGHTS, IL 60411

Grant Number

FPHPA056060

Participating Start Date

1/1/1998

Last Recertification Date

5/10/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06937
1221 N LAKE STREET
AURORA, IL 60506-2454

Pharmacy Comments

01/15/2014 - Pharmacy name/address correction, changed in error on 3/28/2013.

Contract Details

Approval Date

4/17/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Audrey Pennington, Chief Operating Officer
(708) 747-7100

Contract Pharmacy Representative

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

Signed By Date

4/17/2017

340B Drug Pricing Program Database