Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
RWI85004 Southwest Center for HIV/AIDS

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

WALGREENS SPECIALTY PHARMACY, LLC

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188

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

340B Drug Pricing Program Database