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WALGREENS SPECIALTY PHARMACY, LLC
RWI19063B Mazzoni Center
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Covered Entity Details
Entity Name
Mazzoni Center
Subdivision Name
Mazzoni Center Washington West Project Location
Type
Ryan White Part A
340B ID
RWI19063B
Entity Address
1201 Locust Street
Philadelphia, PA 19107
Grant Number
H89HA00013
Participating Start Date
10/1/2022
Last Recertification Date
2/17/2025
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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