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WALGREEN ARIZONA DRUG CO.
CH090090 MARIPOSA COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MARIPOSA COMMUNITY HEALTH CENTER, INC.
Subdivision Name
MARIPOSA COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH090090
Entity Address
1852 N Mastick Way
Nogales, AZ 85621-1063
Grant Number
H80CS00752
Participating Start Date
12/1/1992
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
7/14/2021
Contract Begin Date
8/3/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ed Sicurello, CEO
(520) 761-2128
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2021
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