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WALGREEN ARIZONA DRUG CO.
DSH030024 ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
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Covered Entity Details
Entity Name
ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030024
Entity Address
350 W THOMAS ROAD
PHOENIX, AZ 85013
Medicare Provider Number
030024
Participating Start Date
1/1/2005
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 05505
3502 W CAMELBACK RD
PHOENIX, AZ 85019
Pharmacy Comments
Contract Details
Approval Date
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Jeffrey Jackson, Chief Financial Officer
(602) 406-4618
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/8/2019
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