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WALGREEN CO.
CH092536U JWCH INSTITUTE, INC.
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Covered Entity Details
Entity Name
JWCH INSTITUTE, INC.
Subdivision Name
Wesley Health Centers (Vermont)
Type
HRSA-Funded Health Center
340B ID
CH092536U
Entity Address
954 N. Vermont Ave.
LOS ANGELES, CA 90029-3529
Grant Number
H80CS06673
Participating Start Date
1/1/2015
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16482
1902 MARENGO ST
UNITS 105 AND 106
LOS ANGELES, CA 90033
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2019
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