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WALGREEN CO.
CH094890 VENICE FAMILY CLINIC
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Covered Entity Details
Entity Name
VENICE FAMILY CLINIC
Subdivision Name
VENICE FAMILY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH094890
Entity Address
604 Rose Ave
Venice, CA 90291-2767
Grant Number
H80CS04217
Participating Start Date
10/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05182
60 N HIGHLAND SPRINGS AVE
BANNING, CA 92220
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mitesh G Popat, CEO
(310) 664-7901
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2024
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