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WALGREEN CO.
CH030740 ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES
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Covered Entity Details
Entity Name
ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH030740
Entity Address
241 MONARCH RD
ST CHARLES, VA 24282
Grant Number
H80CS00604
Participating Start Date
10/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17606
16435 WISE ST
SAINT PAUL, VA 24283-0980
Pharmacy Comments
Contract Details
Approval Date
12/28/2017
Contract Begin Date
12/28/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/25/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MALCOLM PERDUE, CEO
(276) 546-5310
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
12/28/2017
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