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WALGREEN CO.
CH072130 NORTHWEST HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HEALTH SERVICES, INC.
Subdivision Name
FAMILY MEDICINE ASSOCIATES
Type
HRSA-Funded Health Center
340B ID
CH072130
Entity Address
2303 Village Dr
Saint Joseph, MO 64506-4954
Grant Number
H80CS00671
Participating Start Date
10/1/1997
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04466
3645 FREDERICK AVENUE
ST JOSEPH, MO 64506
Pharmacy Comments
Contract Details
Approval Date
4/11/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deanna Lamb, CEO
(816) 271-8201
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2018
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