Contract Pharmacy Details

WALGREEN CO.
CHC26576-04 FIVE RIVERS HEALTH CENTERS

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 #12703
537 W. MAIN ST.
XENIA, OH 45385-2811

Pharmacy Comments

Contract Details

Approval Date

4/13/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Diane M. Cummins, Chief Operating Officer
(937) 281-5942

Contract Pharmacy Representative

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

Signed By Date

4/13/2017

340B Drug Pricing Program Database