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WALGREEN ARIZONA DRUG CO.
CH09303N Adelante Healthcare, Inc.
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Covered Entity Details
Entity Name
Adelante Healthcare, Inc.
Subdivision Name
Adelante Healthcare
Type
HRSA-Funded Health Center
340B ID
CH09303N
Entity Address
3033 N Central Ave
Phoenix, AZ 85012-2809
Grant Number
H80CS00140
Participating Start Date
4/1/2019
Last Recertification Date
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 03464
3402 N CENTRAL AVE
PHOENIX, AZ 85012
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Eric Battis, COO
(623) 583-3001 Ext: 1222
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2019
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