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WALGREEN CO.
FQHCLA262 UNIVERSAL MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
UNIVERSAL MEDICAL SERVICES, INC.
Subdivision Name
AXIS MEDICAL CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA262
Entity Address
1801 NICOLLET AVENUE
FLOOR 1
MINNEAPOLIS, MN 55403
Grant Number
LALCS00028
Participating Start Date
7/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09795
1585 RANDOLPH AVE
ST PAUL, MN 55105-2149
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Theodore James, CEO
(612) 823-2947 Ext: 826
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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