340B Drug Pricing Program Database

Pharmacy Name

Walgreens MFC #21373

Pharmacy Address

4100 Dale Earnhardt Way
200
Northlake, TX 76262

Pharmacy Comments

Approval Date

10/9/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Jose Cervantes, Executive Director
(210) 625-7193 Ext: 7193

Contract Pharmacy Representative

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

Signed By Date

10/9/2023