Contract Pharmacy Details

WALGREEN CO.
CH091230 LA CLINICA DE LA RAZA, INC.

Covered Entity Details

Entity Name

LA CLINICA DE LA RAZA, INC.

Subdivision Name

Type

HRSA-Funded Health Center

340B ID

CH091230

Entity Address

1450 FRUITVALE AVE,
3RD FLOOR
OAKLAND, CA 94601

Grant Number

H80CS00631

Participating Start Date

12/1/1992

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04724
3416 DEER VALLEY RD.
ANTIOCH, CA 94531-6650

Pharmacy Comments

Contract Details

Approval Date

9/14/2012

Contract Begin Date

9/14/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/7/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Jane Garcia, CEO
(510) 535-4000

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

9/14/2012

340B Drug Pricing Program Database