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WALGREEN CO.
CH050040 SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
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Covered Entity Details
Entity Name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
Subdivision Name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT C
Type
HRSA-Funded Health Center
340B ID
CH050040
Entity Address
109 California St
Carterville, IL 62918-1923
Grant Number
H80CS00667
Participating Start Date
7/1/1998
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12581
745 E VIENNA ST
ANNA, IL 62906
Pharmacy Comments
Contract Details
Approval Date
9/30/2011
Contract Begin Date
9/30/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patsy R. Jensen, CEO
(618) 985-8221
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/3/2011
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