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WALGREEN CO.
CH093190 TIBURCIO VASQUEZ HEALTH CENTER INCORPORATED
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Covered Entity Details
Entity Name
TIBURCIO VASQUEZ HEALTH CENTER INCORPORATED
Subdivision Name
TIBURCIO VASQUEZ HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH093190
Entity Address
33255 9th St
Union City, CA 94587-2137
Grant Number
H80CS00223
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04659
164 W. JACKSON ST.
HAYWARD, CA 94544
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/22/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David B. Vliet, CEO
(510) 690-6050
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2015
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