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WALGREEN CO.
CH09123V LA CLINICA DE LA RAZA, INC.
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Covered Entity Details
Entity Name
LA CLINICA DE LA RAZA, INC.
Subdivision Name
Havenscourt Health Center
Type
HRSA-Funded Health Center
340B ID
CH09123V
Entity Address
1390 66th Ave
Oakland, CA 94621-3506
Grant Number
H80CS00631
Participating Start Date
7/1/2013
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07274
1456 136TH AVE
SAN LEANDRO, CA 94578-2552
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jane Garcia, CEO
(510) 535-4000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/4/2023
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