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WALGREEN ARIZONA DRUG CO.
CH09307L Mountain Park Health Center
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Covered Entity Details
Entity Name
Mountain Park Health Center
Subdivision Name
Mountain Park Health Center - 303 Baseline
Type
HRSA-Funded Health Center
340B ID
CH09307L
Entity Address
303 E Baseline Rd
Phoenix, AZ 85042-6530
Grant Number
H80CS00141
Participating Start Date
7/1/2018
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 06697
7606 S 7TH ST
PHOENIX, AZ 85042
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John R. Swagert, CEO
(602) 323-3470
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2024
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