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WALGREEN CO.
FP79904 PROJECT VIDA HEALTH CENTER
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Covered Entity Details
Entity Name
PROJECT VIDA HEALTH CENTER
Subdivision Name
PROJECT VIDA HEALTH CENTER DBA NORTHEAST FAMILY PRACTICE AND DENTAL SERVICES
Type
Family Planning (Title X only)
340B ID
FP79904
Entity Address
4875 MAXWELL
EL PASO, TX 79904
Grant Number
FPHPA066196
Participating Start Date
7/1/2015
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09368
12390 EDGEMERE BLVD
EL PASO, TX 79938
Pharmacy Comments
Contract Details
Approval Date
1/6/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bill Schlesinger, CEO
(915) 465-1191 Ext: 207
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/6/2017
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