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WALGREEN ARIZONA DRUG CO.
STD85013 Your Health and Wellness PLLC
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Covered Entity Details
Entity Name
Your Health and Wellness PLLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85013
Entity Address
3326 N 3rd Avenue
Suite 201
Phoenix, AZ 85013
Grant Number
NU51PS005142
Participating Start Date
7/1/2023
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
WALGREENS SPECIALTY PHARMACY #16431
2302 N. CENTRAL AVE.
SUITE 7
PHOENIX, AZ 85004
Pharmacy Comments
Contract Details
Approval Date
5/5/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARK KNOBLAUCH, OWNER
(602) 625-7944
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2023
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