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WALGREENS SPECIALTY PHARMACY, LLC
FQHCLA353 LIVINGSTONE COMMUNITY DEVELOPMENT CORPORATION
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Covered Entity Details
Entity Name
LIVINGSTONE COMMUNITY DEVELOPMENT CORPORATION
Subdivision Name
Livingstone Community Health Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA353
Entity Address
12362 Beach Blvd # 10
Stanton, CA 90680-3944
Grant Number
LALCS31259
Participating Start Date
1/1/2018
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
1/8/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kyung Il Park, CEO
(714) 248-9500
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2018
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