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WALGREEN CO.
CH051028A LAKE SUPERIOR COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Subdivision Name
LSCHC SUPERIOR CLINIC
Type
HRSA-Funded Health Center
340B ID
CH051028A
Entity Address
2222 E 5th St Bldg
Superior, WI 54880
Grant Number
H80CS00811
Participating Start Date
4/1/2004
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03064
2015 TOWER AVENUE
SUPERIOR, WI 54880
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dayle Patterson, CEO
(218) 336-3580
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2017
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