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WALGREEN ARIZONA DRUG CO.
CH06031E LAS CLINICA DEL NORTE INCORPORATED
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Covered Entity Details
Entity Name
LAS CLINICA DEL NORTE INCORPORATED
Subdivision Name
LAS CLINICAS DEL NORTE @ ABIQUIU
Type
HRSA-Funded Health Center
340B ID
CH06031E
Entity Address
BLDG. #186 ON HWY 84
ABIQUIU, NM 87510-0757
Grant Number
H80CS00607
Participating Start Date
10/1/2013
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
WALGREENS CENTRAL FILL #21372
120 N 83RD AVE
STE 200
TOLLESON, AZ 85353
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrea Sandoval, CEO
(575) 581-4728 Ext: 253
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2024
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