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WALGREEN CO.
CH090390 CLINICA SIERRA VISTA
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Covered Entity Details
Entity Name
CLINICA SIERRA VISTA
Subdivision Name
CORPORATE HQ - CLINICA SIERRA VISTA
Type
HRSA-Funded Health Center
340B ID
CH090390
Entity Address
1430 Truxtun Ave STE 400
Bakersfield, CA 93301
Grant Number
H80CS00540
Participating Start Date
1/1/2004
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #12761
41169 GOODWIN WAY STE 110
MADERA, CA 93636
Pharmacy Comments
Contract Details
Approval Date
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Harris, CEO
(661) 635-3050 Ext: 2152
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2018
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