Contract Pharmacy Details

WALGREEN CO.
RWI946091 Primary Care at Home, INC.

Covered Entity Details

Entity Name

Primary Care at Home, INC.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI946091

Entity Address

400 - 29th Street
Suite 306
Oakland, CA 94609

Grant Number

H89HA00018

Participating Start Date

5/10/2021

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16477
3009 BROADWAY
OAKLAND, CA 94611

Pharmacy Comments

Contract Details

Approval Date

5/5/2021

Contract Begin Date

5/13/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Anthony E. Jones, Board Chair
(510) 822-2588

Contract Pharmacy Representative

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

Signed By Date

4/9/2021

340B Drug Pricing Program Database