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WALGREEN CO.
CH07731G COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Subdivision Name
CHC/SEIA Keokuk Clinic
Type
HRSA-Funded Health Center
340B ID
CH07731G
Entity Address
1618 Main Street
Keokuk, IA 52632-3452
Grant Number
H80CS00272
Participating Start Date
10/1/2017
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09476
201 S CENTRAL AVENUE
BURLINGTON, IA 52601-5738
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
RONALD KEMP, CEO
(319) 753-2300 Ext: 100
Contract Pharmacy Representative
Terri Ward, VP
(847) 964-6798
Signed By Date
7/14/2017
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