Contract Pharmacy Details

WALGREEN CO.
FP606049 PLANNED PARENTHOOD OF ILLINOIS

Covered Entity Details

Entity Name

PLANNED PARENTHOOD OF ILLINOIS

Subdivision Name

Loop Health Center

Type

Family Planning (Title X only)

340B ID

FP606049

Entity Address

18 S MICHIGAN AVE
6TH FLOOR
CHICAGO, IL 60603

Grant Number

FPHPA006456-01-00

Participating Start Date

1/1/1998

Last Recertification Date

6/7/2019

Entity Termination Date

1/6/2020

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15992
2500 N CLARK ST
CHICAGO, IL 60614

Pharmacy Comments

Contract Details

Approval Date

4/17/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/6/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

KAI TAO, ASSOCIATE MEDICAL DIRECTOR
(312) 592-6800

Contract Pharmacy Representative

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

Signed By Date

4/17/2013

340B Drug Pricing Program Database