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WALGREEN CO.
CH036820 LA CLINICA DEL PUEBLO
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Covered Entity Details
Entity Name
LA CLINICA DEL PUEBLO
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH036820
Entity Address
2831 15TH STREET NW
WASHINGTON, DC 20009
Grant Number
H80CS08244
Participating Start Date
1/1/2008
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11140
1329 UNIVERSITY BLVD. E
TAKOMA PARK, MD 20912
Pharmacy Comments
Contract Details
Approval Date
7/27/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alicia Wilson, Executive Director
(202) 448-2810
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/27/2017
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