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WALGREEN CO
FP92614 AIDS Services Foundation Orange County dba Radiant Health Centers
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Covered Entity Details
Entity Name
AIDS Services Foundation Orange County dba Radiant Health Centers
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP92614
Entity Address
17982 Sky Park Circle
Suite J
Irvine, CA 92614-6482
Grant Number
FPHPA006537
Participating Start Date
1/1/2019
Last Recertification Date
5/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10629
2560 W BALL RD
ANAHEIM, CA 92804
Pharmacy Comments
Contract Details
Approval Date
10/19/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/2/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Guita Sharifi, CFO
(949) 809-5753
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2018
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