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WALGREEN ARIZONA DRUG CO.
CAH061327-00 Southwest Memorial Hospital
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Covered Entity Details
Entity Name
Southwest Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061327-00
Entity Address
1311 North Mildred
Cortez, CO 81321
Medicare Provider Number
061327
Participating Start Date
4/1/2012
Last Recertification Date
8/21/2024
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
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rick Shrader, Chief Financial Officer
(970) 564-2153
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2021
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