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WALGREEN CO.
STD92506 Planned Parenthood of the Pacific Southwest
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Covered Entity Details
Entity Name
Planned Parenthood of the Pacific Southwest
Subdivision Name
Riverside
Type
Sexually Transmitted Diseases
340B ID
STD92506
Entity Address
3772 TIBBETTS
RIVERSIDE, CA 92506
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 # 06094
3005 MIDWAY DRIVE
SAN DIEGO, CA 92110-4502
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
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
10/12/2021
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