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WALGREEN LOUISIANA CO., INC.
CHC26579-00 C A S S E DENTAL HEALTH INSTITUTE
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Covered Entity Details
Entity Name
C A S S E DENTAL HEALTH INSTITUTE
Subdivision Name
CASSE/Community Health Institute
Type
HRSA-Funded Health Center
340B ID
CHC26579-00
Entity Address
907 POLK STREET
MANSFIELD, LA 71052
Grant Number
H80CS26579
Participating Start Date
7/1/2018
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 07004
2107 AIRLINE DRIVE
BOSSIER CITY, LA 71111-5801
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Beth Chumley, CEO
(318) 688-3350
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2015
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