Contract Pharmacy Details

WALGREEN CO.
RWII39202 My Brother's Keeper, Inc.

Covered Entity Details

Entity Name

My Brother's Keeper, Inc.

Subdivision Name

Open Arms Healthcare Center

Type

Ryan White Part B

340B ID

RWII39202

Entity Address

805 East River Place
Jackson, MS 39202

Grant Number

5X07HA00036-33-00

Participating Start Date

10/1/2017

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05791
1497 CANTON MART RD
JACKSON, MS 39211

Pharmacy Comments

Contract Details

Approval Date

10/4/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

June Gipson, CEO
(769) 216-2455

Contract Pharmacy Representative

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

Signed By Date

10/4/2017

340B Drug Pricing Program Database