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WALGREEN CO.
CH091230 LA CLINICA DE LA RAZA, INC.
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Covered Entity Details
Entity Name
LA CLINICA DE LA RAZA, INC.
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH091230
Entity Address
1450 FRUITVALE AVE,
3RD FLOOR
OAKLAND, CA 94601
Grant Number
H80CS00631
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16477
3009 BROADWAY
OAKLAND, CA 94611
Pharmacy Comments
Contract Details
Approval Date
4/2/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jane Garcia, CEO
(510) 535-4000
Contract Pharmacy Representative
Walgreens
Lisa Villarreal, Analyst, 340B Operations
(847) 964-6183
Signed By Date
4/2/2018
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