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WALGREEN CO.
CH08165S Clinica Campesina Family Health Services
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Covered Entity Details
Entity Name
Clinica Campesina Family Health Services
Subdivision Name
Clinica Family Health - Lafayette
Type
HRSA-Funded Health Center
340B ID
CH08165S
Entity Address
1735 S Public Rd
Lafayette, CO 80026
Grant Number
H80CS00690
Participating Start Date
7/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09598
1041 MAIN STREET
LONGMONT, CO 80501-4302
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
Simon Smith, CEO
(303) 665-3036 Ext: 1003
Contract Pharmacy Representative
Walgreens
Tony Joe Chriscoe, 340 Client Relations Analyst
(847) 315-5806
Signed By Date
10/8/2018
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