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WALGREEN CO.
CH051741J SHALOM HEALTH CARE CENTER, INC.
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Covered Entity Details
Entity Name
SHALOM HEALTH CARE CENTER, INC.
Subdivision Name
Shalom 56th Street - New Access Point
Type
HRSA-Funded Health Center
340B ID
CH051741J
Entity Address
5750 West 56th Street
Indianapolis, IN 46254-1695
Grant Number
H80CS00880
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02796
3003 KESSLER BLVD NORTH DR
INDIANAPOLIS, IN 46222
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leonardo R. Ortega, Executive Director/CEO
(317) 291-7422 Ext: 1105
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2016
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