Contract Pharmacy Details

WALGREEN CO.
FQHCLA263A MAYVIEW COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

MAYVIEW COMMUNITY HEALTH CENTER, INC.

Subdivision Name

MAYVIEW COMMUNITY HEALTH CENTER - MV

Type

Health Center Program Look-Alike

340B ID

FQHCLA263A

Entity Address

900 MIRAMONTE AVENUE
2ND FLOOR
MOUNTAIN VIEW, CA 94040-2457

Grant Number

LALCS00001

Participating Start Date

7/1/2010

Last Recertification Date

1/27/2020

Entity Termination Date

7/1/2020

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 00689
121 E EL CAMINO REAL
MOUNTAIN VIEW, CA 94040

Pharmacy Comments

Contract Details

Approval Date

7/12/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kenneth Graham, CEO
(650) 475-1508

Contract Pharmacy Representative

Mayview Community Health
Ashley Peil, Director of Finance
(650) 475-1508

Signed By Date

7/12/2019

340B Drug Pricing Program Database