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WALGREEN CO
RWI92614 AIDS Services Foundation Orange County dba Radiant Health Centers
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Covered Entity Details
Entity Name
AIDS Services Foundation Orange County dba Radiant Health Centers
Subdivision Name
Type
Ryan White Part A
340B ID
RWI92614
Entity Address
17982 Sky Park Circle
Suite J
Irvine, CA 92614
Grant Number
H89HA00019
Participating Start Date
7/1/2018
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10629
2560 W BALL RD
ANAHEIM, CA 92804
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
6/2/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Guita Sharifi, CFO
(949) 809-5753
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2018
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