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WALGREEN ARIZONA DRUG CO.
HV02485 University of Arizona Board of Regents
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Covered Entity Details
Entity Name
University of Arizona Board of Regents
Subdivision Name
Division of Infectious Disease - Petersen HIV Clinic
Type
Ryan White Part C
340B ID
HV02485
Entity Address
655 N. Alvernon Way
Suite 210
Tucson, AZ 85711
Grant Number
H76HA02485-19-02
Participating Start Date
1/1/2013
Last Recertification Date
2/17/2025
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
Elisha Johnson, Director, Clinical Trials and Contracting
(520) 626-7822
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/20/2021
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