Contract Pharmacy Details

WALGREEN CO.
CH03015N TOTAL HEALTH CARE, INC.

Covered Entity Details

Entity Name

TOTAL HEALTH CARE, INC.

Subdivision Name

Mt. Royal Health Center

Type

HRSA-Funded Health Center

340B ID

CH03015N

Entity Address

922-924 W. NORTH AVE
BALTIMORE, MD 21217-3940

Grant Number

H80CS00068

Participating Start Date

1/1/2016

Last Recertification Date

2/6/2023

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05638
4025 W NORTHERN PKWY
BALTIMORE, MD 21215

Pharmacy Comments

Contract Details

Approval Date

10/2/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/2/2019
CE terminated due to audit finding

Contacts

Covered Entity Signing Official

Faye Royale-Larkins, CEO
(410) 728-4090

Contract Pharmacy Representative

Nohemi Schee, 340b Operations Analyst
(847) 964-4037

Signed By Date

10/2/2015

340B Drug Pricing Program Database