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WALGREEN CO.
CHC11402-00 NORTHEAST COMMUNITY CLINIC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC11402-00
Entity Address
2550 W MAIN STREET, SUITE 301
ALHAMBRA, CA 91801
Grant Number
H80CS12869
Participating Start Date
10/1/2004
Last Recertification Date
2/21/2017
Entity Termination Date
7/1/2017
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12913
1500 E GAGE AVE
LOS ANGELES, CA 90001
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2015
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