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WALGREEN EASTERN CO., INC.
FQHCLA344 Tri-County Family Medicine Program, Inc.
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Covered Entity Details
Entity Name
Tri-County Family Medicine Program, Inc.
Subdivision Name
Tri-County Family Medicine Program, Inc. - Admin
Type
Health Center Program Look-Alike
340B ID
FQHCLA344
Entity Address
10869 State Route 36
Dansville, NY 14437-0601
Grant Number
LALCS00181
Participating Start Date
1/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #17396
21 E STATE ST
MOUNT MORRIS, NY 14510
Pharmacy Comments
Contract Details
Approval Date
3/1/2018
Contract Begin Date
3/2/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicholas H Apostoleris, CSIO
(585) 432-2300
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/1/2018
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