Contract Pharmacy Details

WALGREEN CO.
RWI63110 Vivent Health

Covered Entity Details

Entity Name

Vivent Health

Subdivision Name

Type

Ryan White Part A

340B ID

RWI63110

Entity Address

2653 Locust Street
St. Louis, MO 63103

Grant Number

H89HA00033

Participating Start Date

1/1/2016

Last Recertification Date

2/23/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04834
1225 UNION BLVD
ST LOUIS, MO 63113

Pharmacy Comments

Contract Details

Approval Date

7/5/2016

Contract Begin Date

10/1/2016

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

Ronak Chkshi, 340B Analyst
(847) 964-8308

Signed By Date

7/5/2016

340B Drug Pricing Program Database