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WALGREEN CO.
RWI98122 Lifelong AIDS Alliance
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Covered Entity Details
Entity Name
Lifelong AIDS Alliance
Subdivision Name
Type
Ryan White Part A
340B ID
RWI98122
Entity Address
210 S Lucile Street
Seattle, WA 98108
Grant Number
H89HA00022
Participating Start Date
10/1/2018
Last Recertification Date
2/13/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03632
2400 S. JACKSON ST.
SEATTLE, WA 98144
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Barbara Ebert, Executive Director
(206) 957-1621
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2017
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