Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
FQHCLA463 Mazzoni Center

Covered Entity Details

Entity Name

Mazzoni Center

Subdivision Name

Washington West

Type

Health Center Program Look-Alike

340B ID

FQHCLA463

Entity Address

1201 Locust St.
Philadelphia, PA 19107-5409

Grant Number

LALCS52965

Participating Start Date

4/1/2024

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

WALGREENS SPECIALTY PHARMACY, LLC

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188

Pharmacy Comments

Contract Details

Approval Date

3/11/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/24/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Alecia Manley, Executive Operating Officer
(215) 563-0652

Contract Pharmacy Representative

Walgreens
Cheryl Mullins, 340B Client Relationship Analysist
(847) 527-2432

Signed By Date

1/8/2024

340B Drug Pricing Program Database