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WALGREEN CO.
FQHC638024J United Indian Health Services
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Covered Entity Details
Entity Name
United Indian Health Services
Subdivision Name
ValleyE-4715
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638024J
Entity Address
4715 VALLEY EAST BLVD
Arcata, CA 95521
Grant Number
Participating Start Date
1/1/2025
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
1/14/2025
Contract Begin Date
4/1/2025
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
1/14/2025
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