Contract Pharmacy Details

WALGREEN CO.
CH09312DD FAMILY HEALTH CENTERS OF SAN DIEGO, INC.

Covered Entity Details

Entity Name

FAMILY HEALTH CENTERS OF SAN DIEGO, INC.

Subdivision Name

Grossmont Family Counseling Center

Type

HRSA-Funded Health Center

340B ID

CH09312DD

Entity Address

8851 Center Dr Ste 312
La Mesa, CA 91942-3050

Grant Number

H80CS00224

Participating Start Date

4/1/2017

Last Recertification Date

3/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06094
3005 MIDWAY DRIVE
SAN DIEGO, CA 92110-4502

Pharmacy Comments

Contract Details

Approval Date

10/15/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ricardo Roman, CFO
(619) 906-4603

Contract Pharmacy Representative

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

Signed By Date

10/15/2019

340B Drug Pricing Program Database