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WALGREEN CO.
STD39216 My Brother's Keeper, Inc.
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Covered Entity Details
Entity Name
My Brother's Keeper, Inc.
Subdivision Name
Open Arms Healthcare Center
Type
Sexually Transmitted Diseases
340B ID
STD39216
Entity Address
805 E. River Place
Jackson, MS 39206
Grant Number
NU65PS923762
Participating Start Date
4/1/2014
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05098
955 N STATE ST
JACKSON, MS 39202
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
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
10/12/2017
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