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WALGREEN CO.
CH090710 COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
Subdivision Name
NIPOMO COMMUNITY MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH090710
Entity Address
150 TEJAS PL
NIPOMO, CA 93444-9123
Grant Number
H80CS00621
Participating Start Date
4/1/1996
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15293
4940 VAN NUYS BLVD STE 104
SHERMAN OAKS, CA 91403
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RONALD E. CASTLE, CEO
(805) 459-1835
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2019
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