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WALGREEN CO.
CH07731G COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Subdivision Name
CHC/SEIA Keokuk Clinic
Type
HRSA-Funded Health Center
340B ID
CH07731G
Entity Address
1618 Main Street
Keokuk, IA 52632-3452
Grant Number
H80CS00272
Participating Start Date
10/1/2017
Last Recertification Date
2/17/2025
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
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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