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WALGREEN ARIZONA DRUG CO.
STD85719 Southern Arizona AIDS Foundation
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Covered Entity Details
Entity Name
Southern Arizona AIDS Foundation
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85719
Entity Address
375 S Euclid
Tucson, AZ 85719
Grant Number
NU62PS924675-01-00
Participating Start Date
1/1/2022
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
WALGREENS SPECIALTY PHARMACY #16500
1830 E. BROADWAY BLVD.
SUITE 136
TUCSON, AZ 85719
Pharmacy Comments
Contract Details
Approval Date
11/2/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ravi Grivois-Shah, CEO
(520) 547-6096
Contract Pharmacy Representative
Walgreens
Pratichee Shukla, Pharmacist
(520) 330-3451
Signed By Date
10/4/2021
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