Contract Pharmacy Details

WALGREEN CO.
HV00112 DAMIEN CENTER INC, THE

Covered Entity Details

Entity Name

DAMIEN CENTER INC, THE

Subdivision Name

Type

Ryan White Part C

340B ID

HV00112

Entity Address

DAMIEN CENTER INC
26 N ARSENAL AVE
Indianapolis, IN 46201

Grant Number

H76HA45371

Participating Start Date

4/1/2013

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #16443
26 N. ARSENAL AVE.
INDIANAPOLIS, IN 46201

Pharmacy Comments

Contract Details

Approval Date

10/2/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/19/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Thomas Bartenbach, Executive Director
(317) 632-0123 Ext: 266

Contract Pharmacy Representative

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

Signed By Date

10/2/2017

340B Drug Pricing Program Database