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WALGREEN ARIZONA DRUG CO.
DSH320089 UNM SANDOVAL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
UNM SANDOVAL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320089
Entity Address
3001 BROADMOOR BLVD NE
RIO RANCHO, NM 87144
Medicare Provider Number
320089
Participating Start Date
4/1/2016
Last Recertification Date
8/17/2023
Entity Termination Date
4/1/2024
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
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jamie Silva-Steele, President and CEO
(505) 994-7430
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2021
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