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WALGREEN CO.
CHC28998-00 LA CLINICA TEPEYAC INC
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Covered Entity Details
Entity Name
LA CLINICA TEPEYAC INC
Subdivision Name
Clinica Tepeyac - Clinic
Type
HRSA-Funded Health Center
340B ID
CHC28998-00
Entity Address
5075 LINCOLN ST
DENVER, CO 80216-2015
Grant Number
H80CS28998
Participating Start Date
4/1/2016
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03655
10501 E. COLFAX AVE.
AURORA, CO 80010
Pharmacy Comments
Contract Details
Approval Date
4/25/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/13/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Jim Garcia, Executive Director
(303) 458-5302 Ext: 2941
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/25/2016
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