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WALGREENS SPECIALTY PHARMACY, LLC
STD191071 Mazzoni Center
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Covered Entity Details
Entity Name
Mazzoni Center
Subdivision Name
Mazzoni Center Washington West Project Location
Type
Sexually Transmitted Diseases
340B ID
STD191071
Entity Address
1201 Locust Street
Philadelphia, PA 19107
Grant Number
6NU62PS924545
Participating Start Date
10/1/2022
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
10/11/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alecia Manley, Executive Operating Officer
(215) 563-0652
Contract Pharmacy Representative
Walgreen Co.
Brittany Daurio, Analyst, 340B Client Relationship
(847) 315-6167
Signed By Date
10/11/2022
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