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WALGREEN ARIZONA DRUG CO.
STD85004 Prisma Community Care
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Covered Entity Details
Entity Name
Prisma Community Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85004
Entity Address
1101 N Central Ave
Suite 200
Phoenix, AZ 85004
Grant Number
5 NU62PS924676-03-00
Participating Start Date
1/1/2019
Last Recertification Date
5/5/2025
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
7/6/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jessyca Leach, Executive Director
(602) 595-8115
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/6/2021
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