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WALGREEN CO.
FQHCLA229 STANISLAUS COUNTY HEALTH SERVICES AGENCY
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Covered Entity Details
Entity Name
STANISLAUS COUNTY HEALTH SERVICES AGENCY
Subdivision Name
ADMINISTRATIVE OFFICES
Type
Health Center Program Look-Alike
340B ID
FQHCLA229
Entity Address
1010 10TH STREET
SUITE 6800
MODESTO, CA 95354-0887
Grant Number
LALCS00076
Participating Start Date
1/1/2008
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02842
840 OAKDALE ROAD
MODESTO, CA 95355
Pharmacy Comments
Contract Details
Approval Date
7/5/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GREG DIEDERICH, ASSOCIATE DIRECTOR
(209) 558-7102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/5/2013
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