Contract Pharmacy Details

WALGREEN CO.
FQHCLA425G SUNRISE CLINICS

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 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

340B Drug Pricing Program Database