Contract Pharmacy Details

WALGREEN CO.
CH06031A LAS CLINICA DEL NORTE INCORPORATED

Covered Entity Details

Entity Name

LAS CLINICA DEL NORTE INCORPORATED

Subdivision Name

LAS CLINICAS DEL NORTE @ OJO CAL

Type

HRSA-Funded Health Center

340B ID

CH06031A

Entity Address

BLDG. # 35282 ON HWY 285
OJO CALIENTE, NM 87549-0307

Grant Number

H80CS00607

Participating Start Date

10/1/1995

Last Recertification Date

2/26/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05157
1115 N. RIVERSIDE DR.
ESPANOLA, NM 87532

Pharmacy Comments

Contract Details

Approval Date

4/16/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Andrea Sandoval, CEO
(575) 581-4728 Ext: 253

Contract Pharmacy Representative

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

Signed By Date

4/16/2018

340B Drug Pricing Program Database