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WALGREEN CO
CH050220 INTERCARE COMMUNITY HEALTH NETWORK
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Covered Entity Details
Entity Name
INTERCARE COMMUNITY HEALTH NETWORK
Subdivision Name
INTERCARE ADMINISTRATION
Type
HRSA-Funded Health Center
340B ID
CH050220
Entity Address
50 Industrial Park Rd
Bangor, MI 49013-1246
Grant Number
H80CS00771
Participating Start Date
7/1/1998
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12688
848 S KALAMAZOO ST
PAW PAW, MI 49079-9230
Pharmacy Comments
Contract Details
Approval Date
4/7/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VELMA HENDERSHOTT, CEO
(269) 427-7937 Ext: 200
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/7/2014
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