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WALGREEN CO.
FQHC638032 URBAN INDIAN HEALTH BOARD
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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 SPECIALTY PHARMACY #16477
3009 BROADWAY
OAKLAND, CA 94611
Pharmacy Comments
Contract Details
Approval Date
1/13/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ana O'Connor, Chief Operating Officer
(510) 434-5470
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/13/2017
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