Contract Pharmacy Details

WALGREEN CO.
RW424810 Matthew 25 AIDS Services, Inc.

Covered Entity Details

Entity Name

Matthew 25 AIDS Services, Inc.

Subdivision Name

Type

Ryan White Part D

340B ID

RW424810

Entity Address

1901 Leitchfield Rd Suite A
Owensboro, KY 42303

Grant Number

H12HA24810

Participating Start Date

1/1/2017

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS SPECIALTY PHARMACY #16317
335 MASSACHUSETTS AVENUE
INDIANAPOLIS, IN 46204

Pharmacy Comments

Contract Details

Approval Date

10/25/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

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

Signed By Date

340B Drug Pricing Program Database