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WALGREEN CO
STD60626 Howard Brown Health Centers
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Covered Entity Details
Entity Name
Howard Brown Health Centers
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD60626
Entity Address
6500 N. Clark St.
Chicago, IL 60626
Grant Number
NH25PS004341
Participating Start Date
10/1/2017
Last Recertification Date
5/15/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #15281
2817 N CLARK ST
CHICAGO, IL 60657
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kristin Keglovitz-Baker, SVP, Chief Operating Officer
(773) 388-8901
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2017
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