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WALGREEN ARIZONA DRUG CO.
DSH320001 UNIVERSITY OF NEW MEXICO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF NEW MEXICO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320001
Entity Address
2211 Lomas Blvd NE
ALBUQUERQUE, NM 87106
Medicare Provider Number
320001
Participating Start Date
9/1/1993
Last Recertification Date
8/29/2024
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
7/20/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bonnie White, Chief Financial Officer
(505) 272-1840
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/20/2021
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