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WALGREEN CO.
CH051278N Tapestry 360 Health
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Covered Entity Details
Entity Name
Tapestry 360 Health
Subdivision Name
Tapestry 360 Health - C4 - Broadway
Type
HRSA-Funded Health Center
340B ID
CH051278N
Entity Address
5710 N Broadway St
Chicago, IL 60660-4302
Grant Number
H80CS00215
Participating Start Date
7/1/2015
Last Recertification Date
1/31/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15493
1333 W. BELMONT AVENUE
CHICAGO, IL 60657
Pharmacy Comments
Contract Details
Approval Date
10/17/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gwenn Rausch, CEO
(773) 296-7587
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2017
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