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WALGREEN CO.
FQHCLA341B YEHOWA MEDICAL SERVICES
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Covered Entity Details
Entity Name
YEHOWA MEDICAL SERVICES
Subdivision Name
Yehowa Medical Services
Type
Health Center Program Look-Alike
340B ID
FQHCLA341B
Entity Address
5720 IMPERIAL HWY STE N-O
SOUTH GATE, CA 90280-7518
Grant Number
LALCS00179
Participating Start Date
1/1/2017
Last Recertification Date
2/7/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06249
4351 E IMPERIAL HWY
LYNWOOD, CA 90262
Pharmacy Comments
Contract Details
Approval Date
10/5/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Thomas Tweh, Chief Executive Officer
(323) 776-1500 Ext: 1000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/5/2017
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