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WALGREENS SPECIALTY PHARMACY, LLC
STD875011 La Familia Medical Center
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Covered Entity Details
Entity Name
La Familia Medical Center
Subdivision Name
Alto
Type
Sexually Transmitted Diseases
340B ID
STD875011
Entity Address
1035 Alto Street
Santa Fe, NM 87501
Grant Number
1 NH25PS005180-01-00
Participating Start Date
4/1/2014
Last Recertification Date
5/14/2021
Entity Termination Date
7/1/2022
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
1/17/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jay Jolly, CEO
(505) 955-0310
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2021
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