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WALGREENS SPECIALTY PHARMACY, LLC
CH066580 Centro San Vicente
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Covered Entity Details
Entity Name
Centro San Vicente
Subdivision Name
None
Type
HRSA-Funded Health Center
340B ID
CH066580
Entity Address
8061 Alameda Ave
El Paso, TX 79915-4705
Grant Number
H80CS00637
Participating Start Date
10/1/1995
Last Recertification Date
3/4/2025
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
1/19/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Ilene Paz, CEO
(915) 859-7545 Ext: 1232
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/19/2024
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