Contract Pharmacy Details

WALGREEN CO.
FQHCLA247 HEALTH AND LIFE ORGANIZATION INC.

Covered Entity Details

Entity Name

HEALTH AND LIFE ORGANIZATION INC.

Subdivision Name

SACRAMENTO COMMUNITY CLINIC - SOUTHGATE

Type

Health Center Program Look-Alike

340B ID

FQHCLA247

Entity Address

7275 E. SOUTHGATE DRIVE
SUITE 204
SACRAMENTO, CA 95823

Grant Number

LALCS00018

Participating Start Date

4/1/2009

Last Recertification Date

1/31/2023

Entity Termination Date

10/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15602
4195 NORWOOD AVE
SACRAMENTO, CA 95838

Pharmacy Comments

Contract Details

Approval Date

1/6/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/1/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236

Contract Pharmacy Representative

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

Signed By Date

1/6/2015

340B Drug Pricing Program Database