Contract Pharmacy Details

WALGREEN CO.
CHC08772-09 GRACEMED HEALTH CLINIC, INC.

Covered Entity Details

Entity Name

GRACEMED HEALTH CLINIC, INC.

Subdivision Name

GraceMed Meyer Family Clinic

Type

HRSA-Funded Health Center

340B ID

CHC08772-09

Entity Address

755 W. Lincoln St.
Wichita, KS 67213

Grant Number

H80CS08772

Participating Start Date

4/1/2016

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05769
3333 E CENTRAL AVE
WICHITA, KS 67208-3121

Pharmacy Comments

Contract Details

Approval Date

4/7/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

DAVID C. SANFORD, CEO
(316) 494-2001

Contract Pharmacy Representative

Nick Werth, Analyst, 340B Operations
(847) 964-8648

Signed By Date

4/7/2016

340B Drug Pricing Program Database