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WALGREEN CO.
RWI92614A 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
Type
Ryan White Part A
340B ID
RWI92614A
Entity Address
2010 E. 1st Street
Suite 270
Santa Ana, CA 92705
Grant Number
H89HA00019
Participating Start Date
7/1/2019
Last Recertification Date
1/29/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10397
1715 N BRISTOL ST
SANTA ANA, CA 92706
Pharmacy Comments
Contract Details
Approval Date
6/3/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Guita Sharifi, CFO
(949) 809-5753
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2019
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