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WALGREEN CO.
CH091520 MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
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Covered Entity Details
Entity Name
MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Subdivision Name
Mountain Empire Family Medicine
Type
HRSA-Funded Health Center
340B ID
CH091520
Entity Address
31115 HIGHWAY 94
Campo, CA 91906-3133
Grant Number
H80CS00284
Participating Start Date
10/1/2002
Last Recertification Date
2/7/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11990
9728 WINTER GARDENS BLVD
LAKESIDE, CA 92040
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy Weisiger, CFO
(619) 478-5254 Ext: 229
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2018
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