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WALGREEN CO.
CH036640 CHASE BREXTON HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
CHASE BREXTON HEALTH SERVICES, INC
Subdivision Name
Chase Brexton Health Services, Inc.
Type
HRSA-Funded Health Center
340B ID
CH036640
Entity Address
1111 North Charles Street
Baltimore, MD 21201-5505
Grant Number
H80CS00734
Participating Start Date
4/1/1997
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #16190
301 SAINT PAUL ST
BALTIMORE, MD 21202
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/18/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Robin Brooks, CFO
(410) 752-0954 Ext: 1148
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2017
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