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WALGREEN ARIZONA DRUG CO.
DSH320090 SANTA FE MEDICAL CENTER
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Covered Entity Details
Entity Name
SANTA FE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320090
Entity Address
4801 BECKNER ROAD
SANTA FE, NM 87507
Medicare Provider Number
320090
Participating Start Date
10/1/2020
Last Recertification Date
9/4/2024
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
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erica Downing, VP, Pharmacy and Infusion Services & Chief Pharmacy Officer
(505) 724-8994
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2022
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