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WALGREEN ARIZONA DRUG CO.
RWII79902 Southwest Viral Med
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Covered Entity Details
Entity Name
Southwest Viral Med
Subdivision Name
Type
Ryan White Part B
340B ID
RWII79902
Entity Address
1201 East Schuster Avenue, Building 7
El Paso, TX 79902
Grant Number
X07HA00054
Participating Start Date
4/1/2015
Last Recertification Date
2/22/2025
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
7/10/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ogechika Alozie, President
(915) 222-1300
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/10/2021
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