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Walgreens #21373
CH093590 UNITED COMMUNITY HEALTH CENTER-MARIA AUXILIADORA, INC.
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Covered Entity Details
Entity Name
UNITED COMMUNITY HEALTH CENTER-MARIA AUXILIADORA, INC.
Subdivision Name
CONTINENTAL FAMILY MEDICAL CTR
Type
HRSA-Funded Health Center
340B ID
CH093590
Entity Address
1260 S. CAMPBELL RD
BLDG 1
GREEN VALLEY, AZ 85614
Grant Number
H80CS00416
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
Walgreens #21373
Pharmacy Address
Walgreens Central Fill #21373
4100 Dale Earnhardt Way
STE 200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/28/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Claudette Pippin, Chief Executive Officer - Interim
(520) 407-5602
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2021
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