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WALGREEN ARIZONA DRUG CO.
DSH030115 BANNER ESTRELLA MEDICAL CENTER
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Covered Entity Details
Entity Name
BANNER ESTRELLA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030115
Entity Address
9201 WEST THOMAS ROAD
PHOENIX, AZ 85037
Medicare Provider Number
030115
Participating Start Date
7/1/2007
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 09179
5115 W BASELINE ROAD
LAVEEN, AZ 85339
Pharmacy Comments
Contract Details
Approval Date
12/19/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patricia Rhoden, Chief Financial Officer
(602) 839-8507
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
12/19/2012
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