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WALGREEN CO.
FQHCLA361A Adult and Child Mental Health Center, Inc
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Covered Entity Details
Entity Name
Adult and Child Mental Health Center, Inc
Subdivision Name
Adult and Child Heath - Northwood Plaza
Type
Health Center Program Look-Alike
340B ID
FQHCLA361A
Entity Address
1860 Northwood Plaza
Franklin, IN 46131-1037
Grant Number
LALCS31537
Participating Start Date
4/1/2018
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #10929
1650 EAST RAYMOND STREET
INDIANAPOLIS, IN 46203-4143
Pharmacy Comments
Contract Details
Approval Date
4/9/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/4/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Dan Arens, Chief Operating Officer
(317) 893-0336
Contract Pharmacy Representative
Adult and Child Health
Dan Arens, Chief Operating Officer
(317) 893-0336
Signed By Date
4/9/2018
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