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WALGREEN CO.
STD919112 Planned Parenthood of the Pacific Southwest
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Covered Entity Details
Entity Name
Planned Parenthood of the Pacific Southwest
Subdivision Name
Chula Vista
Type
Sexually Transmitted Diseases
340B ID
STD919112
Entity Address
1295 Broadway #201
Chula Vista, CA 91911
Grant Number
1H25PS005127
Participating Start Date
1/1/2016
Last Recertification Date
5/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09389
310 SYCAMORE AVENUE
VISTA, CA 92083-7702
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Darrah Johnson, CEO
(619) 881-5050 Ext: 6198815050
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2021
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