Contract Pharmacy Details

WALGREEN CO.
FQHCLA329 UNIVERSITY OF WYOMING

Covered Entity Details

Entity Name

UNIVERSITY OF WYOMING

Subdivision Name

University of Wyoming Family Medicine Residency Cheyenne

Type

Health Center Program Look-Alike

340B ID

FQHCLA329

Entity Address

821 E 18th St
Cheyenne, WY 82001-4775

Grant Number

LALCS00162

Participating Start Date

1/1/2015

Last Recertification Date

2/14/2017

Entity Termination Date

10/1/2017

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05838
2304 E LINCOLN WAY
CHEYENNE, WY 82001

Pharmacy Comments

Contract Details

Approval Date

7/17/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/17/2017
Agreement registered in error

Contacts

Covered Entity Signing Official

Dorothy C. Yates, Associate Vice President for Research & Economic Development
(307) 766-5320

Contract Pharmacy Representative

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

Signed By Date

7/17/2017

340B Drug Pricing Program Database