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WALGREEN CO
FQHCLA321 Southern California Medical Center
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Covered Entity Details
Entity Name
Southern California Medical Center
Subdivision Name
Southern California Medical Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA321
Entity Address
8825 Whittier Blvd.
Pico Rivera, CA 90660-2600
Grant Number
LALCS00144
Participating Start Date
1/1/2014
Last Recertification Date
2/11/2019
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #7575
3643 PECK RD
EL MONTE, CA 91731-3530
Pharmacy Comments
Contract Details
Approval Date
4/12/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sheila Busheri, CEO
(818) 324-3780
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2017
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