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WALGREEN ARIZONA DRUG CO.
DSH030024 ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
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Covered Entity Details
Entity Name
ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030024
Entity Address
350 W THOMAS ROAD
PHOENIX, AZ 85013
Medicare Provider Number
030024
Participating Start Date
1/1/2005
Last Recertification Date
8/18/2024
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
7/19/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeffrey Jackson, Chief Financial Officer
(602) 406-4618
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/19/2021
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