Contract Pharmacy Details

WALGREEN CO.
CH091140 SAN MATEO, COUNTY OF

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 #15397
2238 WESTBOROUGH BLVD
SOUTH SAN FRANCISCO, CA 94080

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

340B Drug Pricing Program Database