Contract Pharmacy Details

WALGREEN CO.
CHC08241-15 MISSION CITY COMMUNITY NETWORK, INC.

Covered Entity Details

Entity Name

MISSION CITY COMMUNITY NETWORK, INC.

Subdivision Name

Mission City Community Network - Anaheim

Type

HRSA-Funded Health Center

340B ID

CHC08241-15

Entity Address

1661 W. Broadway Blvd.
Anaheim, CA 92802

Grant Number

H80CS08241

Participating Start Date

10/1/2016

Last Recertification Date

2/1/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #03815
111 S MAIN ST
ORANGE, CA 92868

Pharmacy Comments

Contract Details

Approval Date

10/1/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Nik Gupta, CEO
(818) 895-3100

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/1/2019

340B Drug Pricing Program Database