Contract Pharmacy Details

WALGREEN CO.
FQHC638483 MACT Health Board, Inc.

Covered Entity Details

Entity Name

MACT Health Board, Inc.

Subdivision Name

MACT Medical, Jackson

Type

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

340B ID

FQHC638483

Entity Address

12140 NEW YORK RANCH ROAD
JACKSON, CA 95642

Grant Number

Participating Start Date

1/1/2003

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12528
475 HIGHWAY 49
SUTTER CREEK, CA 95685

Pharmacy Comments

Contract Details

Approval Date

7/7/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Shawver Alexander, Executive Director
(209) 754-6258

Contract Pharmacy Representative

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

Signed By Date

7/7/2020

340B Drug Pricing Program Database