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WALGREEN CO.
CH053130 CIRCLE FAMILY CARE, INC
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Covered Entity Details
Entity Name
CIRCLE FAMILY CARE, INC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH053130
Entity Address
5002 WEST MADISON
CHICAGO, IL 60644
Grant Number
H80CS00400
Participating Start Date
7/1/1998
Last Recertification Date
2/19/2018
Entity Termination Date
1/14/2019
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15507
3800 W MADISON STREET SUITE 101
CHICAGO, IL 60624
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tanya Ford, CEO
(773) 379-1000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2018
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