Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO.
DSH030065 BANNER DESERT MEDICAL CENTER

Covered Entity Details

Entity Name

BANNER DESERT MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH030065

Entity Address

1400 SOUTH DOBSON ROAD
MESA, AZ 85202

Medicare Provider Number

030065

Participating Start Date

1/1/2007

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

WALGREEN ARIZONA DRUG CO.

Pharmacy Address

DBA: WALGREENS # 03768
6404 SOUTH MCCLINTOCK DR.
TEMPE, AZ 85283

Pharmacy Comments

Contract Details

Approval Date

12/19/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/17/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Scott Leckey, CFO
(480) 412-3214

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

12/19/2012

340B Drug Pricing Program Database