Contract Pharmacy Details

WALGREEN CO.
RWI46201 Damien Center

Covered Entity Details

Entity Name

Damien Center

Subdivision Name

Type

Ryan White Part A

340B ID

RWI46201

Entity Address

26 N. Arsenal Ave
Indianapolis, IN 46201

Grant Number

H89HA11463

Participating Start Date

4/1/2013

Last Recertification Date

2/9/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #16443
26 N. ARSENAL AVE.
INDIANAPOLIS, IN 46201

Pharmacy Comments

Contract Details

Approval Date

4/2/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/19/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Jerry W Parsons, Vice President and Chief Compliance Officer
(317) 632-0123 Ext: 224

Contract Pharmacy Representative

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

Signed By Date

4/2/2018

340B Drug Pricing Program Database