Contract Pharmacy Details

WALGREEN CO.
RWI39 CHW-CARE PROGRAM AND CLINICS

Covered Entity Details

Entity Name

CHW-CARE PROGRAM AND CLINICS

Subdivision Name

ST. MARY MEDICAL CENTER

Type

Ryan White Part A

340B ID

RWI39

Entity Address

1043 ELM AVENUE
SUITE 300
LONG BEACH, CA 90813

Grant Number

LOS ANGELES EMA / H89HA00016

Participating Start Date

12/1/1992

Last Recertification Date

2/10/2017

Entity Termination Date

4/1/2018

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05650
2627 PACIFIC AVENUE
LONG BEACH, CA 90806-2610

Pharmacy Comments

Contract Details

Approval Date

10/15/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/19/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

BECKY YOUREX, CLINICAL SUPERVISOR
(562) 624-4903

Contract Pharmacy Representative

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

Signed By Date

10/15/2014

340B Drug Pricing Program Database