Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO.
HV02485 University of Arizona Board of Regents

Covered Entity Details

Entity Name

University of Arizona Board of Regents

Subdivision Name

Division of Infectious Disease - Petersen HIV Clinic

Type

Ryan White Part C

340B ID

HV02485

Entity Address

655 N. Alvernon Way
Suite 210
Tucson, AZ 85711

Grant Number

H76HA02485-19-02

Participating Start Date

1/1/2013

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

WALGREEN ARIZONA DRUG CO.

Pharmacy Address

WALGREENS SPECIALTY PHARMACY #16500
1830 E. BROADWAY BLVD.
SUITE 136
TUCSON, AZ 85719

Pharmacy Comments

Contract Details

Approval Date

7/11/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Stephen A Klotz, Principal Investigator/Professor of Medicine
(520) 626-6887

Contract Pharmacy Representative

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

Signed By Date

7/11/2018

340B Drug Pricing Program Database