Contract Pharmacy Details

WALGREEN CO.
RWI30309 Positive Impact Health Centers, Inc.

Covered Entity Details

Entity Name

Positive Impact Health Centers, Inc.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI30309

Entity Address

523 Church St
Decatur, GA 30030

Grant Number

H89HA00007

Participating Start Date

7/1/2014

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06032
595 PIEDMONT AVE NE STE 100
ATLANTA, GA 30308-2480

Pharmacy Comments

Contract Details

Approval Date

10/11/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Larry M. Lehman, CEO
(678) 990-6450 Ext: 450

Contract Pharmacy Representative

Walgreens
Jim Guth, Regional Manager, 340B Client Relationship
(847) 964-4749

Signed By Date

10/11/2017

340B Drug Pricing Program Database