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WALGREEN CO.
CH091140 SAN MATEO, COUNTY OF
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Covered Entity Details
Entity Name
SAN MATEO, COUNTY OF
Subdivision Name
39th Outpatient Clinics
Type
HRSA-Funded Health Center
340B ID
CH091140
Entity Address
222 W 39th Ave
San Mateo, CA 94403-4364
Grant Number
H80CS00051
Participating Start Date
10/1/2001
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02939
333 EL CAMINO REAL
SAN BRUNO, CA 94066
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHESTER J. KUNNAPPILLY, CEO
(650) 573-2305
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2016
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