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WALGREEN CO.
FQHCLA81B NORTHEAST COMMUNITY CLINIC, INC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic - Community Medical Alliance
Type
Health Center Program Look-Alike
340B ID
FQHCLA81B
Entity Address
4129 E Gage Ave
Bell, CA 90201
Grant Number
LALCS00033
Participating Start Date
4/1/2011
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09137
14250 PRAIRIE AVE
HAWTHORNE, CA 90250-7908
Pharmacy Comments
Contract Details
Approval Date
2/29/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/29/2024
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