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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 SPECIALTY PHARMACY #16368
3745 S LA BREA AVE STE C & D
LOS ANGELES, CA 90016
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
Mitesh G Popat, CEO
(310) 664-7901
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2025
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