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WALGREEN HASTINGS CO.
FQHCLA425G SUNRISE CLINICS
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Covered Entity Details
Entity Name
SUNRISE CLINICS
Subdivision Name
Sunrise Clinics-LV2
Type
Health Center Program Look-Alike
340B ID
FQHCLA425G
Entity Address
2515 Ridge Runner Rd
Las Vegas, NM 87701-4972
Grant Number
LALCS40211
Participating Start Date
1/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN HASTINGS CO.
Pharmacy Address
DBA: WALGREENS # 02425
620 MILLS AVE
LAS VEGAS, NM 87701
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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