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WALGREEN CO.
STD79902 Southwest Viral Med
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Covered Entity Details
Entity Name
Southwest Viral Med
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD79902
Entity Address
1201 East Schuster Avenue, Building 7
El Paso, TX 79902
Grant Number
NH25PS005182
Participating Start Date
10/1/2017
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21172
2701 N MESA ST STE 100A
EL PASO, TX 79902
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ogechika Alozie, President
(915) 222-1300
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2020
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