Contract Pharmacy Details

WALGREEN CO.
FP92126 Operation Samahan Inc.

Covered Entity Details

Entity Name

Operation Samahan Inc.

Subdivision Name

Mira Mesa Clinic

Type

Family Planning (Title X only)

340B ID

FP92126

Entity Address

10737 Camino Ruiz
San Diego, CA 92126

Grant Number

FPHPA096061

Participating Start Date

7/1/2012

Last Recertification Date

5/12/2016

Entity Termination Date

4/1/2017

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11406
10512 MISSION GORGE RD
SANTEE, CA 92071-3146

Pharmacy Comments

Contract Details

Approval Date

4/21/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2017

Contacts

Covered Entity Signing Official

Emelina Quisumbing, CEO
(702) 769-9725

Contract Pharmacy Representative

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

Signed By Date

4/21/2016

340B Drug Pricing Program Database