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WALGREEN EASTERN CO., INC.
CH0112200 INDIAN STREAM HEALTH CENTER
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Covered Entity Details
Entity Name
INDIAN STREAM HEALTH CENTER
Subdivision Name
INDIAN STREAM HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0112200
Entity Address
141 Corliss Ln
Colebrook, NH 03576-3206
Grant Number
H80CS06655
Participating Start Date
7/1/2007
Last Recertification Date
2/24/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19398
91 MAIN ST
COLEBROOK, NH 03576-3060
Pharmacy Comments
Contract Details
Approval Date
2/1/2018
Contract Begin Date
2/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gregory Allen Culley, Interim CEO and Medical Director
(603) 388-2473
Contract Pharmacy Representative
Indian Stream Health Center Pharmacy
Jessica Remillard, Pharmacist In Charge
(603) 388-2450
Signed By Date
2/1/2018
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