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WALGREEN ARIZONA DRUG CO.
PED033302-00 PHOENIX CHILDREN'S HOSPITAL
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Covered Entity Details
Entity Name
PHOENIX CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED033302-00
Entity Address
1919 E THOMAS ROAD
PHOENIX, AZ 85016
Medicare Provider Number
033302
Participating Start Date
4/1/2010
Last Recertification Date
9/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS #12739
15450 N TATUM BLVD
PHOENIX, AZ 85032
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
Kari Cornicelli, Executive Vice President and Chief Financial Officer
(602) 933-5468
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2021
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