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WALGREEN CO.
CHC26576-04 FIVE RIVERS HEALTH CENTERS
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Covered Entity Details
Entity Name
FIVE RIVERS HEALTH CENTERS
Subdivision Name
Five Rivers Samaritan Homeless Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26576-04
Entity Address
921 S EDWIN C MOSES BLVD
DAYTON, OH 45417-3464
Grant Number
H80CS26576
Participating Start Date
1/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04520
1260 E CENTRAL
MIAMISBURG, OH 45342
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diane Cummins, Chief Operating Officer
(937) 734-6838
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2016
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