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WALGREEN CO.
CHC24201-05 Urban Community Action Projects
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Covered Entity Details
Entity Name
Urban Community Action Projects
Subdivision Name
Health To Hope Clinics - Mobile Unit # 3
Type
HRSA-Funded Health Center
340B ID
CHC24201-05
Entity Address
2880 Hulen Place
Riverside, CA 92057
Grant Number
H80CS24201
Participating Start Date
7/1/2018
Last Recertification Date
1/30/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09183
1301 W BASELINE ST
SAN BERNARDINO, CA 92411-1707
Pharmacy Comments
Contract Details
Approval Date
10/4/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Beth Wagner, COO
(951) 595-4165
Contract Pharmacy Representative
Walgreens
Ted Kountouris, Regional Manager
(626) 806-1853
Signed By Date
10/4/2018
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