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WALGREEN CO.
FQHCLA469 LYON-MARTIN COMMUNITY HEALTH SERVICES
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Covered Entity Details
Entity Name
LYON-MARTIN COMMUNITY HEALTH SERVICES
Subdivision Name
Lyon-Martin Community Health Services
Type
Health Center Program Look-Alike
340B ID
FQHCLA469
Entity Address
1735 Mission St
San Francisco, CA 94103-2417
Grant Number
LALCS53018
Participating Start Date
10/1/2024
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05365
6100 MISSION STREET
DALY CITY, CA 94014
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Jackson James Miller Jaffe, CEO
(415) 901-7108
Contract Pharmacy Representative
Walgreens
Karl Meehan, VP Health System Programs
(847) 315-2663
Signed By Date
10/15/2024
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