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WALGREENS MAIL SERVICE, INC.
CH06301C LA CLINICA DE FAMILIA, INC.
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Covered Entity Details
Entity Name
LA CLINICA DE FAMILIA, INC.
Subdivision Name
SAN MIGUEL MEDICAL & DENTAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CH06301C
Entity Address
18420 S. Highway 28
SAN MIGUEL, NM 88058
Grant Number
H80CS00316
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALGREENS MAIL SERVICE, INC.
Pharmacy Address
8350 S RIVER PARKWAY
TEMPE, AZ 85284
Pharmacy Comments
Contract Details
Approval Date
12/7/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Suzan Martinez de Gonzales, CEO
(575) 526-1105
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/26/2012
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