Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO.
RWI85004 Southwest Center for HIV/AIDS

Covered Entity Details

Entity Name

Southwest Center for HIV/AIDS

Subdivision Name

Type

Ryan White Part A

340B ID

RWI85004

Entity Address

1101 N Central Ave
Suite 200
Phoenix, AZ 85004

Grant Number

H89HA11478

Participating Start Date

1/1/2019

Last Recertification Date

1/31/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN ARIZONA DRUG CO.

Pharmacy Address

DBA: WALGREENS # 04138
7939 E MCDOWELL RD.
SCOTTSDALE, AZ 85257

Pharmacy Comments

Contract Details

Approval Date

1/6/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jessyca Leach, Executive Director
(602) 595-8115

Contract Pharmacy Representative

Walgreen's
Oscar Campos, Analyst, 340B Client Relationship
(847) 964-7748

Signed By Date

1/6/2022

340B Drug Pricing Program Database