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WALGREEN CO.
FQHCLA425A SUNRISE CLINICS
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Covered Entity Details
Entity Name
SUNRISE CLINICS
Subdivision Name
Santa Rosa High School School Based Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA425A
Entity Address
717 S 3rd Street, Lion Care Office FL 1
Santa Rosa, NM 88435-2411
Grant Number
LALCS40211
Participating Start Date
7/1/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16544
933 SAN MATEO BLVD NE STE 501
ALBUQUERQUE, NM 87108
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
Randal Brown, CEO
(575) 472-4311
Contract Pharmacy Representative
Walgreens
Karl Meehan, VP Health System Programs
(847) 315-2663
Signed By Date
4/12/2024
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