340B Drug Pricing Program Database
WALGREEN CO.
FQHC638015 RIVERSIDE - SAN BERNARDINO COUNTY INDIAN HEALTH INC - information as of 4/25/2025 9:25:20 PM
Covered Entity Details
Entity Name
RIVERSIDE - SAN BERNARDINO COUNTY INDIAN HEALTH INC
Subdivision Name
Morongo Indian Health Clinic
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638015
Entity Address
11555 1/2 POTRERO RD
Banning, CA 92220
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07410
29910-A MURRIETA HOT SPRINGS ROAD
MURRIETA, CA 92563
Pharmacy Comments
Contract Details
Approval Date
1/30/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/10/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jess Montoya, CEO
(951) 849-4761
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/30/2014
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