Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO.
STD85004 Prisma Community Care

Covered Entity Details

Entity Name

Prisma Community Care

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD85004

Entity Address

1101 N Central Ave
Suite 200
Phoenix, AZ 85004

Grant Number

5 NU62PS924676-03-00

Participating Start Date

1/1/2019

Last Recertification Date

5/8/2024

Pharmacy Details

Pharmacy Name

WALGREEN ARIZONA DRUG CO.

Pharmacy Address

DBA: WALGREENS # 04228
5125 W. NORTHERN AVE.
GLENDALE, AZ 85301

Pharmacy Comments

Contract Details

Approval Date

7/3/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jessyca Leach, Executive Director
(602) 595-8115

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/3/2024

340B Drug Pricing Program Database