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WALGREEN ARIZONA DRUG CO.
CH061290 LA CASA DE BUENA SALUD
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Covered Entity Details
Entity Name
LA CASA DE BUENA SALUD
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH061290
Entity Address
1515 WEST FIR
PORTALES, NM 88130
Grant Number
H80CS00404
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
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
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carmen Pacheco, COO
(575) 356-6695 Ext: 3801
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2021
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