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WALGREEN ARIZONA DRUG CO.
DSH030064 Banner - University Medical Center Tucson
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Covered Entity Details
Entity Name
Banner - University Medical Center Tucson
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030064
Entity Address
1625 North Campbell Avenue
TUCSON, AZ 85719
Medicare Provider Number
030064
Participating Start Date
1/1/1997
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21393
3627 N CAMPBELL AVE
TUCSON, AZ 85719
Pharmacy Comments
Contract Details
Approval Date
10/12/2011
Contract Begin Date
10/12/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MISTY HANSEN, CHIEF FINANCIAL OFFICER
(520) 694-6365
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/10/2011
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