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WALGREEN CO
FP92706 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
AIDS Services Foundation Orange County
Type
Family Planning (Title X only)
340B ID
FP92706
Entity Address
2708 Westminster Avenue
110
Santa Ana, CA 92706
Grant Number
FPHPA006470
Participating Start Date
1/1/2019
Last Recertification Date
5/29/2020
Entity Termination Date
4/1/2021
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
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Guita Sharifi, CFO
(949) 809-5753
Contract Pharmacy Representative
Laguna Drug
Dave Olsen, Owner
(949) 307-8335
Signed By Date
10/15/2018
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