Contract Pharmacy Details

WALGREEN CO.
FQHC638032 URBAN INDIAN HEALTH BOARD

Covered Entity Details

Entity Name

URBAN INDIAN HEALTH BOARD

Subdivision Name

DBA NATIVE AMERICAN HEALTH CENTER

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638032

Entity Address

2950 International Blvd.
OAKLAND, CA 94601

Grant Number

Participating Start Date

1/1/1995

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03032
15850 E 14TH STREET
SAN LEANDRO, CA 94578

Pharmacy Comments

Contract Details

Approval Date

3/4/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/21/2017
Pharmacy closed

Contacts

Covered Entity Signing Official

Ana O'Conner, COO
(510) 535-4496

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/15/2013

340B Drug Pricing Program Database