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WALGREEN ARIZONA DRUG CO.
CH063010 LA CLINICA DE FAMILIA, INC.
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Covered Entity Details
Entity Name
LA CLINICA DE FAMILIA, INC.
Subdivision Name
LCDF Administration Office
Type
HRSA-Funded Health Center
340B ID
CH063010
Entity Address
385 Calle de Alegra BLDG A
Las Cruces, NM 88005
Grant Number
H80CS00316
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
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
Virgil Medina, CEO
(575) 526-1105
Contract Pharmacy Representative
Walgreens
Karl Meeham, Vice President, Health Systems Programs
(847) 964-2663
Signed By Date
7/15/2021
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