Contract Pharmacy Details

WALGREEN CO.
RWI900152B AIDS Healthcare Foundation

Covered Entity Details

Entity Name

AIDS Healthcare Foundation

Subdivision Name

AHF Healthcare Center - San Diego

Type

Ryan White Part A

340B ID

RWI900152B

Entity Address

3580 5th Avenue
San Diego, CA 92103-5017

Grant Number

H89HA00001

Participating Start Date

4/1/2017

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16490
4130 LA JOLLA VILLAGE DR STE 103
LA JOLLA, CA 92037

Pharmacy Comments

Contract Details

Approval Date

10/12/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Philip Ho, Senior Director of Pharmacy and 340B Compliance
(323) 860-5323

Contract Pharmacy Representative

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

Signed By Date

10/12/2020

340B Drug Pricing Program Database