Contract Pharmacy Details

WALGREEN CO.
FQHC638032 URBAN INDIAN HEALTH BOARD

Covered Entity Details

Entity Name

URBAN INDIAN HEALTH BOARD

Subdivision Name

DBA NATIVE AMERICAN HEALTH CENTER

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638032

Entity Address

2950 International Blvd.
OAKLAND, CA 94601

Grant Number

Participating Start Date

1/1/1995

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #15330
5809 FOOTHILL BLVD
OAKLAND, CA 94605

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ana O'Connor, Chief Operating Officer
(510) 434-5470

Contract Pharmacy Representative

Native American Health Center
Charlene Harrison, Site Director
(510) 535-4472

Signed By Date

1/15/2020

340B Drug Pricing Program Database