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WALGREEN CO.
HV00708B Matthew 25 AIDS Services, Inc.
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Covered Entity Details
Entity Name
Matthew 25 AIDS Services, Inc.
Subdivision Name
Type
Ryan White Part C
340B ID
HV00708B
Entity Address
1901 Leitchfield Road
Suite A
Owensboro, KY 42303
Grant Number
H76HA00708
Participating Start Date
10/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS SPECIALTY PHARMACY #16317
335 MASSACHUSETTS AVENUE
INDIANAPOLIS, IN 46204
Pharmacy Comments
Contract Details
Approval Date
7/8/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Cynthia T. Burton, Administrator
(270) 826-0200
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/8/2016
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