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WALGREEN CO.
CH091670 VISTA COMMUNITY CLINIC
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Covered Entity Details
Entity Name
VISTA COMMUNITY CLINIC
Subdivision Name
VCC: VALE TERRACE
Type
HRSA-Funded Health Center
340B ID
CH091670
Entity Address
1000 Vale Terrace Dr.
Vista, CA 92084-5218
Grant Number
H80CS00282
Participating Start Date
4/1/1996
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09486
18296 COLLIER AVENUE
LAKE ELSINORE, CA 92530-2754
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Fernando Sanudo, CEO
(760) 631-5000 Ext: 4
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2015
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