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WALGREEN CO.
CH07731E COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA
Subdivision Name
HAMILTON CLINIC
Type
HRSA-Funded Health Center
340B ID
CH07731E
Entity Address
951 BROADWAY STREET
HAMILTON, IL 62341
Grant Number
H80CS00272
Participating Start Date
7/1/2009
Last Recertification Date
2/9/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16528
1704 INGERSOLL AVE STE 102
DES MOINES, IA 50309
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
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
RONALD KEMP, CEO
(319) 753-2300 Ext: 100
Contract Pharmacy Representative
Walgreen
Steven Donnelly, Store Manager
(515) 657-8896
Signed By Date
10/12/2017
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