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WALGREEN CO.
CH09107BT San Francisco Community Clinic Consortium
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Covered Entity Details
Entity Name
San Francisco Community Clinic Consortium
Subdivision Name
Saint Anthony Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH09107BT
Entity Address
150 Golden Gate Ave Fl 2
San Francisco, CA 94102-3810
Grant Number
H80CS00049
Participating Start Date
7/1/2021
Last Recertification Date
2/24/2022
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16533
1100 VAN NESS AVE STE C
SAN FRANCISCO, CA 94109
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Kate O'Connor, Clinic Director
(415) 592-2711
Contract Pharmacy Representative
WALGREENS #16533
Venus Ho, Pharmacy Manager
(415) 783-1909
Signed By Date
4/15/2021
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