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WALGREEN CO.
CH06031D LAS CLINICA DEL NORTE INCORPORATED
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Covered Entity Details
Entity Name
LAS CLINICA DEL NORTE INCORPORATED
Subdivision Name
LAS CLINICAS DEL NORTE SCH CLN
Type
HRSA-Funded Health Center
340B ID
CH06031D
Entity Address
BLDG. K ON SR 554
OJO CALIENTE, NM 87510-0307
Grant Number
H80CS00607
Participating Start Date
10/1/2013
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
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