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WALGREEN ARIZONA DRUG CO.
CAH321306-00 LINCOLN COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
LINCOLN COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321306-00
Entity Address
211 SUDDERTH
RUIDOSO, NM 88345
Medicare Provider Number
321306
Participating Start Date
1/1/2011
Last Recertification Date
8/30/2024
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
7/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Scott Graham, VP-PDS Clinical Support Srvc
(505) 841-1872
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/9/2021
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