Contract Pharmacy Details

WALGREEN CO.
FQHC638024F UNITED INDIAN HEALTH SERVICES, INC.

Covered Entity Details

Entity Name

UNITED INDIAN HEALTH SERVICES, INC.

Subdivision Name

Eureka Lucas St

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638024F

Entity Address

2505 Lucas St.
Suite A
Eureka, CA 95501

Grant Number

Participating Start Date

7/1/2020

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05863
2525 HARRIS STREET
EUREKA, CA 95503-4805

Pharmacy Comments

Contract Details

Approval Date

10/18/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Christopher Myers, Chief Clinical Officer
(707) 825-4070

Contract Pharmacy Representative

United Indian Health Services
Kanako Miyamoto, Pharmacy Director
(707) 825-4095

Signed By Date

10/18/2023

340B Drug Pricing Program Database