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WALGREEN CO.
CH092535A SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC
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Covered Entity Details
Entity Name
SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC
Subdivision Name
SJFFCC ADULT & PEDIATRICS
Type
HRSA-Funded Health Center
340B ID
CH092535A
Entity Address
2880 Story Rd STE A
San Jose, CA 95127-3942
Grant Number
H80CS06646
Participating Start Date
10/1/2009
Last Recertification Date
1/27/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01179
1795 E. CAPITOL EXP
SAN JOSE, CA 95121
Pharmacy Comments
Contract Details
Approval Date
4/18/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Salvador Chavarin, Chief Executive Officer
(408) 729-4290
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/18/2013
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