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WALGREEN ARIZONA DRUG CO.
RWI85004 Southwest Center for HIV/AIDS
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Covered Entity Details
Entity Name
Southwest Center for HIV/AIDS
Subdivision Name
Type
Ryan White Part A
340B ID
RWI85004
Entity Address
1101 N Central Ave
Suite 200
Phoenix, AZ 85004
Grant Number
H89HA11478
Participating Start Date
1/1/2019
Last Recertification Date
1/31/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 06063
1825 W BETHANY HOME RD
PHOENIX, AZ 85015-2512
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michelle Perez, Finance Director
(602) 595-8115
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2019
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