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WALGREEN ARIZONA DRUG CO.
STD850131 Your Health and Wellness PLLC
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Covered Entity Details
Entity Name
Your Health and Wellness PLLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD850131
Entity Address
635 W Glenrosa Avenue
Suite 104
Phoenix, AZ 85013
Grant Number
NU51PS005142
Participating Start Date
10/1/2023
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA WALGREENS #12087
13723 N. LITCHFIELD RD.
SURPRISE, AZ 85379
Pharmacy Comments
Contract Details
Approval Date
4/7/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Knoblauch, Owner
(602) 625-7944
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/7/2024
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