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WALGREEN ARIZONA DRUG CO.
CH091300 CANYONLANDS COMMUNITY HEALTH CARE
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Covered Entity Details
Entity Name
CANYONLANDS COMMUNITY HEALTH CARE
Subdivision Name
Canyonlands Healthcare - Lake Powell
Type
HRSA-Funded Health Center
340B ID
CH091300
Entity Address
467 VISTA AVENUE
PAGE, AZ 86040
Grant Number
H80CS00448
Participating Start Date
10/1/1998
Last Recertification Date
2/11/2025
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
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Hansen, CEO
(928) 645-6600
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2021
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