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WALGREEN CO.
CH09122M BAY AREA COMMUNITY HEALTH
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Covered Entity Details
Entity Name
BAY AREA COMMUNITY HEALTH
Subdivision Name
Aborn Rd. Health Clinic
Type
HRSA-Funded Health Center
340B ID
CH09122M
Entity Address
2060 Aborn Rd Ste 125
San Jose, CA 95121-1586
Grant Number
H80CS02326
Participating Start Date
10/1/2020
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02169
5536 MONTEREY HWY
SAN JOSE, CA 95138
Pharmacy Comments
Contract Details
Approval Date
8/27/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Zettie D Page, CEO
(760) 902-5249
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
8/27/2020
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