Contract Pharmacy Details

WALGREEN CO.
CHC24115-00 SABAN FREE CLINIC, THE

Covered Entity Details

Entity Name

SABAN FREE CLINIC, THE

Subdivision Name

Beverly Health Center

Type

HRSA-Funded Health Center

340B ID

CHC24115-00

Entity Address

8405 Beverly Blvd.
Los Angeles, CA 90048-3401

Grant Number

H80CS24115

Participating Start Date

10/1/2012

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #15190
1399 ROXBURY DR
LOS ANGELES, CA 90035

Pharmacy Comments

Contract Details

Approval Date

10/8/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Muriel Nouwezem, CEO
(323) 337-1707

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/8/2018

340B Drug Pricing Program Database