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WALGREEN CO.
CH1010860 WATERFALL CLINIC INC
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Covered Entity Details
Entity Name
WATERFALL CLINIC INC
Subdivision Name
WATERFALL CLINIC, INC.
Type
HRSA-Funded Health Center
340B ID
CH1010860
Entity Address
1890 Waite St STE 1
North Bend, OR 97459-1229
Grant Number
H80CS08771
Participating Start Date
1/1/2008
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12901
3411 BROADWAY ST.
NORTH BEND, OR 97459
Pharmacy Comments
Contract Details
Approval Date
7/9/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrea Zamora, CFO
(808) 213-5055
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/9/2018
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