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WALGREEN CO.
CHC24115-00 SABAN FREE CLINIC, THE
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Covered Entity Details
Entity Name
SABAN FREE CLINIC, THE
Subdivision Name
Beverly Health Center
Type
HRSA-Funded Health Center
340B ID
CHC24115-00
Entity Address
8405 Beverly Blvd.
Los Angeles, CA 90048-3401
Grant Number
H80CS24115
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16368
3745 S LA BREA AVE STE C & D
LOS ANGELES, CA 90016
Pharmacy Comments
Contract Details
Approval Date
1/10/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Muriel Nouwezem, CEO
(323) 337-1707
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/10/2019
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