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WALGREEN CO.
CH056620 ALIVIO MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
ALIVIO MEDICAL CENTER, INC
Subdivision Name
ALIVIO MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH056620
Entity Address
2355 S. WESTERN AVE
CHICAGO, IL 60608-3837
Grant Number
H80CS00116
Participating Start Date
7/1/1998
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06641
1614 W 47TH STREET
CHICAGO, IL 60609-3245
Pharmacy Comments
Contract Details
Approval Date
10/17/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ESTHER CORPUZ, CHIEF EXECUTIVE OFFICER
(312) 829-6304
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2014
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