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WALGREEN ARIZONA DRUG CO.
CH06723B HIDALGO MEDICAL SERVICES
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Covered Entity Details
Entity Name
HIDALGO MEDICAL SERVICES
Subdivision Name
HMS Mimbres Community Clinic
Type
HRSA-Funded Health Center
340B ID
CH06723B
Entity Address
2672 Hwy 35
San Lorenzo, NM 88041
Grant Number
H80CS00744
Participating Start Date
1/1/2007
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
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Otero, CEO
(575) 590-7090
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2021
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