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WALGREEN CO.
FQHC638024 UNITED INDIAN HEALTH SERVICES
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Covered Entity Details
Entity Name
UNITED INDIAN HEALTH SERVICES
Subdivision Name
POTAWAT CLINIC
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638024
Entity Address
1600 WEEOT WAY
ARCATA, CA 95521
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04681
1424 BROADWAY STREET
EUREKA, CA 95501
Pharmacy Comments
Contract Details
Approval Date
7/6/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathleen Terra, Chief Medical Officer
(707) 825-4057
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/6/2015
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