Contract Pharmacy Details

WALGREEN CO.
CH090250 CLINICAS DE SALUD DEL PUEBLO,Inc.

Covered Entity Details

Entity Name

CLINICAS DE SALUD DEL PUEBLO,Inc.

Subdivision Name

Innercare K Street

Type

HRSA-Funded Health Center

340B ID

CH090250

Entity Address

1166 K St
Brawley, CA 92227-2737

Grant Number

H80CS00733

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07765
47900 WASHINGTON STREET
LA QUINTA, CA 92253

Pharmacy Comments

Contract Details

Approval Date

6/1/2012

Contract Begin Date

6/1/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/21/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Yvonne Bell, CEO
(760) 344-9951

Contract Pharmacy Representative

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

Signed By Date

6/15/2012

340B Drug Pricing Program Database