Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO.
DSH450024 UNIVERSITY MEDICAL CENTER OF EL PASO

Covered Entity Details

Entity Name

UNIVERSITY MEDICAL CENTER OF EL PASO

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450024

Entity Address

4815 ALAMEDA AVE.
EL PASO, TX 79905

Medicare Provider Number

450024

Participating Start Date

12/1/1992

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN ARIZONA DRUG CO.

Pharmacy Address

WALGREENS CENTRAL FILL #21372
120 N 83RD AVE
STE 200
TOLLESON, AZ 85353

Pharmacy Comments

Contract Details

Approval Date

7/2/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MICHAEL NUNEZ, CFO
(915) 521-7626

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/2/2021

340B Drug Pricing Program Database