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WALGREEN CO
FP91343 MISSION CITY COMMUNITY NETWORK, INC.
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Covered Entity Details
Entity Name
MISSION CITY COMMUNITY NETWORK, INC.
Subdivision Name
MISSION CITY COMMUNITY NETWORK, INC.
Type
Family Planning (Title X only)
340B ID
FP91343
Entity Address
15206 PARTHENIA STREET
NORTH HILLS, CA 91343-5305
Grant Number
FPHPA096061
Participating Start Date
1/1/2011
Last Recertification Date
6/9/2016
Entity Termination Date
7/1/2016
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11449
4616 DE LONGPRE AVE
LOS ANGELES, CA 90027
Pharmacy Comments
Contract Details
Approval Date
4/17/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/17/2013
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