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WALGREEN CO.
CH09122S BAY AREA COMMUNITY HEALTH
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Covered Entity Details
Entity Name
BAY AREA COMMUNITY HEALTH
Subdivision Name
Story Rd Health Clinic
Type
HRSA-Funded Health Center
340B ID
CH09122S
Entity Address
2880 Story Rd Ste A
San Jose, CA 95127-3942
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 #09516
770 1ST ST
GILROY, CA 95020
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
3/21/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Zettie D Page, CEO
(760) 902-5249
Contract Pharmacy Representative
Walgreens
Ted Kountouris, Regional Manager
(626) 806-1853
Signed By Date
8/27/2020
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