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WALGREEN CO.
FQHC638366 Riverside - San Bernardino County Indian Health, Inc.
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Covered Entity Details
Entity Name
Riverside - San Bernardino County Indian Health, Inc.
Subdivision Name
SAN MANUEL INDIAN HEALTH CLINIC
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638366
Entity Address
11980 Mt. Vernon Ave
Grand Terrace, CA 92313
Grant Number
Participating Start Date
7/1/1996
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01995
40420 MURRIETA HOT SPRINGS
MURRIETA, CA 92563
Pharmacy Comments
Contract Details
Approval Date
1/30/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/27/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jess Montoya, CEO
(951) 849-4761
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/30/2014
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