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WALGREEN ARIZONA DRUG CO.
RWII86305 Northland Cares
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Covered Entity Details
Entity Name
Northland Cares
Subdivision Name
Northland Cares
Type
Ryan White Part B
340B ID
RWII86305
Entity Address
3188 N Windsong Drive
Suite A
Prescott Valley, AZ 86314
Grant Number
X07HA00080
Participating Start Date
7/1/2013
Last Recertification Date
2/27/2025
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
7/7/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vonda Ann Chisholm, Executive Director
(928) 776-4612 Ext: 104
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/7/2021
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