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WALGREEN CO.
CHC12872-00 WellSpace Health
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Covered Entity Details
Entity Name
WellSpace Health
Subdivision Name
J Street Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC12872-00
Entity Address
1820 J Street
Sacramento, CA 95811-3010
Grant Number
H80CS12872
Participating Start Date
7/1/2018
Last Recertification Date
3/7/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04170
4200 ARDEN WAY
SACRAMENTO, CA 95864
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/22/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alasdair Jonathan Porteus, CEO
(916) 550-5444
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2018
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