Contract Pharmacy Details

WALGREEN CO.
CHC29011-00 PACKARD HEALTH, INC.

Covered Entity Details

Entity Name

PACKARD HEALTH, INC.

Subdivision Name

Packard Health Carpenter

Type

HRSA-Funded Health Center

340B ID

CHC29011-00

Entity Address

2650 Carpenter Road
Ann Arbor, MI 48108

Grant Number

H80CS29011

Participating Start Date

4/1/2016

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #21156
3500 WASHTENAW AVE STE E3
ANN ARBOR, MI 48104

Pharmacy Comments

Contract Details

Approval Date

4/2/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mark Jacoby, CFO
(734) 971-1073

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