Contract Pharmacy Details

WALGREEN CO
RWI914031 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER - VALLEY

Type

Ryan White Part A

340B ID

RWI914031

Entity Address

4940 VAN NUYS BLVD.
SUITE 200
SHERMAN OAKS, CA 91403

Grant Number

H89HA00016

Participating Start Date

7/1/2005

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #09491
10955 MAGNOLIA BLVD
NORTH HOLLYWOOD, CA 91601

Pharmacy Comments

Contract Details

Approval Date

1/16/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/16/2023

340B Drug Pricing Program Database