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WALGREEN ARIZONA DRUG CO.
DSH030023 FLAGSTAFF MEDICAL CENTER
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Covered Entity Details
Entity Name
FLAGSTAFF MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030023
Entity Address
1200 NORTH BEAVER
FLAGSTAFF, AZ 86001
Medicare Provider Number
030023
Participating Start Date
7/1/2009
Last Recertification Date
8/22/2024
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
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifford F Loader, Chief Financial Officer
(928) 773-2282
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2021
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