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WALGREEN CO.
FQHCLA425H SUNRISE CLINICS
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Covered Entity Details
Entity Name
SUNRISE CLINICS
Subdivision Name
SB-WLV HS MS
Type
Health Center Program Look-Alike
340B ID
FQHCLA425H
Entity Address
1024 South Pacific Street
Las Vegas, NM 87701
Grant Number
LALCS40211
Participating Start Date
1/1/2024
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
4/15/2024
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
4/15/2024
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