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WALGREEN CO.
CH092536AF JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Wesley Health Centers -- Lynwood High School
Type
HRSA-Funded Health Center
340B ID
CH092536AF
Entity Address
12124 Bullis Rd
Ste B104
Lynwood, CA 90262-5106
Grant Number
H80CS06673
Participating Start Date
7/1/2018
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12881
460 S BROADWAY
LOS ANGELES, CA 90013
Pharmacy Comments
Contract Details
Approval Date
7/27/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/27/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/27/2020
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