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WALGREEN CO.
CH09167R VISTA COMMUNITY CLINIC
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Covered Entity Details
Entity Name
VISTA COMMUNITY CLINIC
Subdivision Name
VCC: Lake Elsinore Health Center
Type
HRSA-Funded Health Center
340B ID
CH09167R
Entity Address
31361 Riverside Dr
Lake Elsinore, CA 92530-7807
Grant Number
H80CS00282
Participating Start Date
1/1/2024
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09486
18296 COLLIER AVENUE
LAKE ELSINORE, CA 92530-2754
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele Lambert, CFO
(760) 216-5803
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2024
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