Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO.
DSH060013 Mercy Hospital

Covered Entity Details

Entity Name

Mercy Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH060013

Entity Address

1010 THREE SPRINGS BLVD.
DURANGO, CO 81301

Medicare Provider Number

060013

Participating Start Date

1/1/2020

Last Recertification Date

9/10/2024

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

Patrick Sharp, Chief Executive Officer
(970) 764-3907

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/15/2021

340B Drug Pricing Program Database