340B Drug Pricing Program Database


CH09307K MOUNTAIN PARK HEALTH CENTER (Active) - information as of 6/26/2025 3:09:03 AM

Main Details
MOUNTAIN PARK HEALTH CENTER
Mountain Park Health Center - Central Office
HRSA-Funded Health Center
BPS-H80-021683
CH09307K
H80CS00141


Additional Details
Active
3/7/2018
4/1/2018
3/7/2018
2/13/2025

Contacts

Mountain Park Health Center
John R. Swagert, CEO
(602) 323-3470

Mountain Park Health Center
Maegan Anne Burris, Associate Director of Pharmacy
(602) 323-8180

Addresses

3003 N Central Ave
Ste 1600
Phoenix, AZ 85012-2908

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH093070ActiveBPS-H80-000998MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Baseline635 E Baseline Rd PhoenixAZ
CH09307BActiveBPS-H80-010130MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Maryvale6601 W. Thomas PhoenixAZ
CH09307CActiveBPS-H80-010170MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Goodyear140 N Litchfield Rd Ste 200 GoodyearAZ
CH09307DActiveBPS-H80-014363MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Gateway3830 E VAN BUREN ST PHOENIXAZ
CH09307ETerminatedBPS-H80-005333MOUNTAIN PARK HEALTH CENTERMOUNTAIN PARK HEALTH CENTER2702 N. 3rd St. PhoenixAZ
CH09307FActiveBPS-H80-019497MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Tempe1840 E Broadway Rd TempeAZ
CH09307GActiveBPS-H80-015223MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Christown5517 N 17th Ave PhoenixAZ
CH09307HTerminatedBPS-H80-015312MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Sunrise17624 N. 31st Avenue PhoenixAZ
CH09307JActiveBPS-H80-015311MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Atkinson4222 N 51st Ave PhoenixAZ
CH09307KActiveBPS-H80-021683MOUNTAIN PARK HEALTH CENTERMountain Park Health Center - Central Office3003 N Central Ave PhoenixAZ
CH09307LActiveBPS-H80-031454Mountain Park Health CenterMountain Park Health Center - 303 Baseline303 E Baseline Rd PhoenixAZ
CH09307MTerminatedBPS-H80-018626Mountain Park Health CenterMountain Park Health Center - 303 E Baseline Suite 300303 East Baseline Road PhoenixAZ
CH09307NActiveBPS-H80-030110Mountain Park Health CenterMountain Park Health Center - Goodyear Suite 106140 N Litchfield Rd Ste 106 GoodyearAZ
CH09307PActiveBPS-H80-030080Mountain Park Health CenterMountain Park Health Center - Goodyear Suite 102140 N Litchfield Rd Ste 102 GoodyearAZ
CH09307QTerminatedBPS-H80-030510Mountain Park Health CenterTemporary - Mountain Park Health Center 325 E Baseline325 E Baseline Rd PhoenixAZ
CH09307RTerminatedBPS-H80-031041Mountain Park Health CenterTemporary Site- Mountain Park Health Center303 E Baseline Rd Ste 105 PhoenixAZ
CH09307SActiveBPS-H80-032975Mountain Park Health CenterMountain Park Health Center - Balsz1300 N 48th Street PhoenixAZ
CH09307TActiveBPS-H80-021358Mountain Park Health CenterMountain Park Health Center - Goodyear Suite 100140 N Litchfield Rd Ste 100 GoodyearAZ
CH09307UActiveBPS-H80-035716Mountain Park Health CenterMountain Park Health Center - 325 E Baseline325 E Baseline Rd PhoenixAZ
CH09307VActiveBPS-H80-033849Mountain Park Health CenterMountain Park Health Center - Glendale6975 W Glendale Ave GlendaleAZ
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH093070ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/01/2025  
CH093070ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/01/2025  
CH093070ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/01/2025  
CH093070ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/01/2025  
CH093070ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/01/2025  
CH093070ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/01/2025  
CH093070ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280907/01/2024  
CH093070ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09327 6021 S CENTRAL AVE
PHOENIXAZ8504207/01/2021 08/26/2023
CH093070ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 03383 7550 SOUTH 19TH AVE.
PHOENIXAZ8504107/01/2021  
CH093070ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09314 3440 WEST GLENDALE AVE
PHOENIXAZ8505107/01/2021  
CH093070ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09225 2406 EAST THOMAS RD.
PHOENIXAZ8501601/01/2024  
CH093070CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2024  
CH093070CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2024  
CH093070CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2024  
CH093070CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2024  
CH093070CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2024  
CH093070CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2024  
CH093070CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2024  
CH093070CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/01/2024  
CH093070CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2024  
CH093070CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2024  
CH093070CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2024  
CH093070GENOA HEALTHCARE LLC3001 N 33RD AVE RM 210
PHOENIXAZ8501704/01/2025  
CH093070GENOA HEALTHCARE LLC1465 W CHANDLER BLVD, BLDG A, SUITE P
CHANDLERAZ8522404/01/2025  
CH093070GENOA HEALTHCARE LLC1255 W BASELINE RD STE 138
MESAAZ8520204/01/2025  
CH093070GENOA HEALTHCARE LLC1642 S PRIEST DR BLDG 6, STE 101
TEMPEAZ8528104/01/2025  
CH093070GENOA HEALTHCARE LLC4909 E MCDOWELL RD
PHOENIXAZ8500804/01/2025  
CH093070GENOA HEALTHCARE LLC5222 E BASELINE RD STE 100
GILBERTAZ8523404/01/2025  
CH093070GENOA HEALTHCARE LLC4451 E OAK ST STE P1
PHOENIXAZ8500804/01/2025  
CH093070GENOA HEALTHCARE LLC3540 E BASELINE RD STE 150
PHOENIXAZ8504204/01/2025  
CH093070GENOA HEALTHCARE LLC4616 N 51ST AVE STE 108
PHOENIXAZ8503104/01/2025  
CH093070GENOA HEALTHCARE LLC1035 E JEFFERSON ST STE P1
PHOENIXAZ8503404/01/2025  
CH093070GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY #10229 280 N. AVONDALE BLVD
AVONDALEAZ8532310/01/2020  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 09222 4275 W. THOMAS RD.
PHOENIXAZ8501910/01/2020  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07263 10707 W. CAMELBACK RD.
PHOENIXAZ8503710/01/2020  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 01744 6650 W. LOWER BUCKEYE RD.
PHOENIXAZ8504310/01/2020  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 06718 5835 W. INDIAN SCHOOL RD.
PHOENIXAZ8503110/01/2020  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07872 7499 W. BETHANY HOME RD.
GLENDALEAZ8530310/01/2020 06/06/2024
CH093070GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17231 9830 W LOWER BUCKEYE RD
TOLLESONAZ8535307/01/2021  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00040 1424 W BASELINE RD
TEMPEAZ8528307/01/2021 06/01/2023
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07078 3303 S. RURAL
TEMPEAZ8528207/01/2021 07/20/2023
CH093070GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17418 5715 N 19TH AVE
PHOENIXAZ8501507/01/2021  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05778 4040 N. 19TH AVE.
PHOENIXAZ8501507/01/2021  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05892 5050 W. BASELINE RD.
LAVEENAZ8533907/01/2021  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 03500 1625 N. 44TH ST.
PHOENIXAZ8500807/01/2021  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07860 1615 E. BASELINE RD.
PHOENIXAZ8504207/01/2021  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00033 1750 E BROADWAY RD
TEMPEAZ8528207/01/2021  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 06862 1850 W. DUNLAP AVE.
PHOENIXAZ8502107/01/2021 11/15/2022
CH093070GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17024 2140 E BASELINE RD
PHOENIXAZ8504201/01/2023  
CH093070GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16292 7409 W VIRGINIA AVE
PHOENIXAZ8503510/01/2023  
CH093070GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05950 855 E. ELLIOT ROAD
TEMPEAZ8528401/01/2024  
CH09307FGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07860 1615 E. BASELINE RD.
PHOENIXAZ8504207/01/2024  
CH09307JGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 09222 4275 W. THOMAS RD.
PHOENIXAZ8501907/01/2024  
CH09307TGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 06718 5835 W. INDIAN SCHOOL RD.
PHOENIXAZ8503107/01/2024  
CH093070GOODYEAR CVS, L.L.C.DBA: CVS/PHARMACY # 03749 2840 N. DYSART RD.
GOODYEARAZ8539507/01/2024  
CH093070OPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/01/2025  
CH093070OPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260104/01/2025  
CH093070OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276504/01/2025  
CH093070OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520404/01/2025  
CH093070OPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/01/2025  
CH093070OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/01/2025  
CH093070OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/01/2025  
CH093070OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/01/2025  
CH093070OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/01/2025  
CH093070OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/01/2025  
CH093070PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2024  
CH093070PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2024  
CH093070PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2024  
CH093070PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #3129 1002 EAST MCDOWELL ROAD
PHOENIXAZ8500607/01/2024  
CH093070SMITH'S FOOD & DRUG CENTERDBA FRY'S FOOD AND DRUG #135 4505 E THOMAS ROAD
PHOENIXAZ8501810/01/2016  
CH093070SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #126 6601 W. INDIAN SCHOOL RD.
PHOENIXAZ8503310/01/2016  
CH093070SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD STORES #89 11425 W BUCKEYE RD
AVONDALEAZ8532310/01/2016  
CH093070SMITH'S FOOD AND DRUG CTRDBA FRY'S FOOD & DRUG #101 3232 S MILL AVENUE
TEMPEAZ8528210/01/2019  
CH093070SMITHS FOOD & DRUG CENTERDBA FRYS FOOD & DRUG #87 5140 W BASELINE RD
LAVEENAZ8533910/01/2019  
CH09307VSMITHS FOOD & DRUG CENTERDBA FRYS FOOD & DRUG #87 5140 W BASELINE RD
LAVEENAZ8533907/01/2024  
CH093070SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #46 520 E BASELINE ROAD
PHOENIXAZ8504010/01/2016  
CH093070SMITHS FOOD & DRUG CENTERSFRY'S PHARMACY #002 3036 E THOMAS RD
PHOENIXAZ8501610/01/2016  
CH093070SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #43 2700 W BASELINE
TEMPEAZ8528310/01/2016  
CH093070SMITHS FOOD & DRUG CENTERSDBA FRY'S FOOD & DRUG #610 4230 W. MCDOWELL ROAD
PHOENIXAZ8500910/01/2019  
CH093070SMITHS FOOD AND DRUG CENTERSDBA FRYS FOOD & DRUG #81 2250 E BASELINE RD
PHOENIXAZ8504010/01/2016  
CH09307DSMITHS FOOD AND DRUG CENTERSDBA FRYS FOOD & DRUG #81 2250 E BASELINE RD
PHOENIXAZ8504007/01/2024  
CH093070THOMAS PHOENIX CVS, L.L.C.DBA: CVS/PHARMACY # 03625 8245 W. THOMAS RD.
PHOENIXAZ8503310/01/2020  
CH093070WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2020  
CH093070WAL-MART PHARMACY 10-15492020 N 75TH AVE SUITE 1
PHOENIXAZ8503510/01/2016  
CH093070WAL-MART PHARMACY 10-25153721 EAST THOMAS ROAD
PHOENIX (EAST)AZ8501810/01/2016  
CH093070WAL-MART PHARMACY 10-37716150 SOUTH 35TH AVE
PHOENIXAZ8504110/01/2016  
CH09307GWAL-MART PHARMACY 10-37716150 SOUTH 35TH AVE
PHOENIXAZ8504107/01/2024  
CH093070WAL-MART PHARMACY 10-42932435 EAST BASELINE ROAD
PHOENIXAZ8504210/01/2016  
CH09307SWAL-MART PHARMACY 10-42932435 EAST BASELINE ROAD
PHOENIXAZ8504207/01/2024  
CH093070WAL-MART PHARMACY 10-51895250 WEST INDIAN SCHOOL RD
PHOENIX (MARYVALE)AZ8503110/01/2016  
CH09307NWAL-MART PHARMACY 10-51895250 WEST INDIAN SCHOOL RD
PHOENIX (MARYVALE)AZ8503107/01/2024  
CH093070WAL-MART PHARMACY 10-53317575 WEST LOWER BUCKEYE ROAD
PHOENIXAZ8504310/01/2016  
CH093070WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2020  
CH093070WALGREEN ARIZONA DRUG CODBA: WALGREENS #10111 3434 W. SOUTHERN AVE
PHOENIXAZ8504106/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 01197 1745 E SOUTHERN AVE
TEMPEAZ85282-762506/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 01272 5101 WEST INDIAN SCHOOL
PHOENIXAZ8503106/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 01969 6006 N 67TH AVE
GLENDALEAZ8530106/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02243 387 N ESTRELLA PKWY
GOODYEARAZ8533806/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02398 925 WEST BASELINE SUITE 108
TEMPEAZ8528306/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03163 3420 N. SCOTTSDALE RD
SCOTTSDALEAZ8525106/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03464 3402 N CENTRAL AVE
PHOENIXAZ8501206/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03789 3605 E THOMAS RD
PHOENIXAZ8501806/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04138 7939 E MCDOWELL RD.
SCOTTSDALEAZ8525706/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04422 3945 E SOUTHERN AVE
PHOENIXAZ8504006/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04909 2921 N. 83RD AVE.
PHOENIXAZ8503306/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05505 3502 W CAMELBACK RD
PHOENIXAZ8501906/11/2012 09/30/2020
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05893 705 EAST MCDOWELL RD
PHOENIXAZ8500606/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05937 4315 W MCDOWELL RD
PHOENIXAZ8503506/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06021 1620 N 59TH AVE
PHOENIXAZ8503506/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06063 1825 W BETHANY HOME RD
PHOENIXAZ85015-251206/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06177 1135 N MESA DRIVE
MESAAZ8520106/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06535 2420 E BASELINE ROAD
PHOENIXAZ8504206/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06697 7606 S 7TH ST
PHOENIXAZ8504206/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06784 2024 W MAIN STREET
MESAAZ85201-680206/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06872 2930 N 67TH AVE
PHOENIXAZ8503306/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07375 1840 W SOUTHERN AVE
PHOENIXAZ85041-463106/11/2012 02/20/2024
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07387 10710 WEST MCDOWELL ROAD
AVONDALEAZ8539206/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07663 8280 W LOWER BUCKEYE ROAD
PHOENIXAZ8504306/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 09179 5115 W BASELINE ROAD
LAVEENAZ8533906/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 11182 1130 W. SOUTHERN AVE
MESAAZ8521006/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 11610 2000 S. MILL AVE.
TEMPEAZ8528206/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 13870 4875 E ELLIOT RD.
PHOENIXAZ8504406/11/2012  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05776 1451 N DYSART ROAD
AVONDALEAZ8532310/01/2015  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05504 4249 W GLENDALE AVE
PHOENIXAZ8505101/01/2016  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03087 5625 E THOMAS RD
PHOENIXAZ8501807/01/2021  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05668 8301 W CAMELBACK
PHOENIXAZ8503707/01/2021  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03769 1616 E. THOMAS
PHOENIXAZ8501607/01/2021  
CH093070WALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200 		TOLLESONAZ8535301/01/2022  
CH093070WALGREEN ARIZONA DRUG CO.WALGREENS SPECIALTY PHARMACY #16431 2302 N. CENTRAL AVE.
SUITE 7 		PHOENIXAZ8500404/01/2023  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS #12334 1654 N PEBBLE CREEK PKWY
GOODYEARAZ8539504/01/2023  
CH093070WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03657 3361 NORTH LITCHFIELD RD
GOODYEARAZ8539501/01/2024  
CH09307LWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06697 7606 S 7TH ST
PHOENIXAZ8504207/01/2024  
CH09307CWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03789 3605 E THOMAS RD
PHOENIXAZ8501807/01/2024  
CH093070WALGREEN CODBA: WALGREENS 2370 E MAIN STREET
WOODLANDCA9577609/10/2012 09/30/2015
CH093070WALGREEN CODBA: WALGREENS 17500 PERRIS BLVD
MORENO VALLEYCA92551-954709/10/2012 09/30/2015
CH093070WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528409/10/2012 11/08/2016
CH093070WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2024  
CH093070WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2024  
CH093070WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2024  
CH093070WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275610/01/2023  
CH093070Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/23/2024 12:12:53 PM2/13/2025 12:47:11 PM2/13/2025 12:47 PM
DetailsLast Recertification DateUpdateRecertification2/3/2023 4:41:17 PM2/23/2024 12:12:53 PM2/23/2024 12:12 PM
ContactsPrimary ContactUpdateChange RequestSoto, Mary Associate Director of Pharmacy Mountain Park Health Center 6025863026Burris, Maegan Anne Associate Director of Pharmacy Mountain Park Health Center 602323818011/16/2023 11:16 AM
DetailsLast Recertification DateUpdateRecertification2/18/2022 1:41:36 PM2/3/2023 4:41:17 PM2/3/2023 4:41 PM
DetailsLast Recertification DateUpdateRecertification2/22/2021 5:36:23 PM2/18/2022 1:41:36 PM2/18/2022 1:41 PM
DetailsLast Recertification DateUpdateRecertification1/28/2020 1:56:47 PM2/22/2021 5:36:23 PM2/22/2021 5:36 PM
DetailsLast Recertification DateUpdateRecertification2/19/2019 7:48:42 AM1/28/2020 1:56:47 PM1/28/2020 1:56 PM
AddressesMain AddressUpdateRecertification 3003 N. Central Ave., Suite 1600 Phoenix, AZ 85012-2908 3003 N Central Ave Ste 1600 Phoenix, AZ 85012-29082/19/2019 7:48 AM
DetailsLast Recertification DateUpdateRecertification 2/19/2019 7:48:42 AM2/19/2019 7:48 AM
DetailsStateUpdate ApprovedActive4/1/2018 12:00 AM
ContactsSigned ByInsertNew Registration Swagert, John R. CEO Mountain Park Health Center 60232334703/7/2018 12:29 PM
Details340B IDUpdateNew Registration CH09307K3/7/2018 12:29 PM
DatesParticipating Approval DateUpdateNew Registration 3/7/2018 12:29:13 PM3/7/2018 12:29 PM
DetailsStateUpdateNew RegistrationPendingApproved3/7/2018 12:29 PM
DatesSigned By DateUpdateNew Registration 3/7/2018 11:52:14 AM3/7/2018 12:29 PM
DatesStart DateUpdateNew Registration 4/1/2018 12:00:00 AM3/7/2018 12:29 PM
AddressesMain AddressInsertNew Registration  3003 N. Central Ave., Suite 1600 Phoenix, AZ 85012-29083/7/2018 4:50 AM
ContactsAuthorizing OfficialInsertNew Registration Swagert, John R. CEO Mountain Park Health Center 60232334703/7/2018 4:50 AM
ContactsPrimary ContactInsertNew Registration Soto, Mary Associate Director of Pharmacy Mountain Park Health Center 60258630263/7/2018 4:50 AM
DetailsLast Recertification DateInsertNew Registration  3/7/2018 4:50 AM
DetailsGrant NumberInsertNew Registration H80CS001413/7/2018 4:50 AM
Details340B IDInsertNew Registration  3/7/2018 4:50 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  3/7/2018 4:50 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  3/7/2018 4:50 AM
DetailsMedicare Provider NumberInsertNew Registration  3/7/2018 4:50 AM
DetailsEntity NameInsertNew Registration MOUNTAIN PARK HEALTH CENTER3/7/2018 4:50 AM
DetailsProgram CodeInsertNew Registration CH3/7/2018 4:50 AM
DetailsEntity SubnameInsertNew Registration Mountain Park Health Center - Central Office3/7/2018 4:50 AM
DatesParticipating Approval DateInsertNew Registration  3/7/2018 4:50 AM
DetailsStateInsertNew Registration Pending3/7/2018 4:50 AM
DatesRegistration DateInsertNew Registration 3/7/2018 4:50:02 AM3/7/2018 4:50 AM
DatesSigned By DateInsertNew Registration  3/7/2018 4:50 AM
DatesStart DateInsertNew Registration  3/7/2018 4:50 AM
TerminationsTermination CommentsInsertNew Registration  3/7/2018 4:50 AM
TerminationsTermination DateInsertNew Registration  3/7/2018 4:50 AM
TerminationsTermination Effective DateInsertNew Registration  3/7/2018 4:50 AM
TerminationsTermination ReasonInsertNew Registration  3/7/2018 4:50 AM