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WALGREEN CO.
CHC24098-04 SOUTHERN ILLINOIS UNIVERSITY
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine-Lincoln
Type
HRSA-Funded Health Center
340B ID
CHC24098-04
Entity Address
109 3rd Street
Lincoln, IL 62656
Grant Number
H80CS24098
Participating Start Date
7/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05976
603 WOODLAWN RD
LINCOLN, IL 62656
Pharmacy Comments
Contract Details
Approval Date
4/18/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Walgreens
Tonya Poole, Client Analyst
(847) 964-7987
Signed By Date
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