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WALGREEN CO.
RWII63110 Vivent Health
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Covered Entity Details
Entity Name
Vivent Health
Subdivision Name
Type
Ryan White Part B
340B ID
RWII63110
Entity Address
2653 Locust Street
St. Louis, MO 63103
Grant Number
X07HA00030
Participating Start Date
10/1/2015
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15311
115 N EUCLID AVE STE A
SAINT LOUIS, MO 63108
Pharmacy Comments
Contract Details
Approval Date
7/9/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/21/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Cheryl Oliver, Executive Director
(314) 645-6451 Ext: 212
Contract Pharmacy Representative
Richard Day, Implementation Coordinator
(847) 964-8175
Signed By Date
7/9/2015
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