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WALGREEN CO.
CH09107B SF COMMUNITY CLINIC CONSORTIUM
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Covered Entity Details
Entity Name
SF COMMUNITY CLINIC CONSORTIUM
Subdivision Name
ADULT MEDICINE CLINIC
Type
HRSA-Funded Health Center
340B ID
CH09107B
Entity Address
1001 POTRERO AVENUE, ROOM 1M
SAN FRANCISCO, CA 94110
Grant Number
H80CS00049
Participating Start Date
9/30/2005
Last Recertification Date
2/13/2017
Entity Termination Date
7/1/2017
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03711
1189 POTRERO AVE
SAN FRANCISCO, CA 94110
Pharmacy Comments
Contract Details
Approval Date
10/15/2010
Contract Begin Date
11/3/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
10/8/2010
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