Contract Pharmacy Details

WALGREEN CO.
CHC30718-03 SIGNATURE HEALTH, INC.

Covered Entity Details

Entity Name

SIGNATURE HEALTH, INC.

Subdivision Name

Signature Health Garfield Heights Health Center

Type

HRSA-Funded Health Center

340B ID

CHC30718-03

Entity Address

5410 Transportation Blvd.
Garfield Heights, OH 44125-5300

Grant Number

H80CS30718

Participating Start Date

7/1/2017

Last Recertification Date

Entity Termination Date

4/1/2018

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 02226
5090 TURNEY ROAD
GARFIELD HEIGHTS, OH 44125

Pharmacy Comments

Contract Details

Approval Date

1/15/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jonathan Albert Lee, CEO
(440) 953-9999 Ext: 705133

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/15/2018

340B Drug Pricing Program Database