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WALGREEN ARIZONA DRUG CO.
DSH030036 CHANDLER REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CHANDLER REGIONAL MEDICAL CENTER
Subdivision Name
CHANDLER REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH030036
Entity Address
1955 W. Frye Road
CHANDLER, AZ 85224
Medicare Provider Number
030036
Participating Start Date
1/1/2015
Last Recertification Date
9/4/2020
Entity Termination Date
10/5/2021
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
7/16/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Eric Sorensen, CFO
(480) 728-3144 Ext: 4807283144
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2021
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