Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO
DSH320001 UNIVERSITY OF NEW MEXICO HOSPITAL

Covered Entity Details

Entity Name

UNIVERSITY OF NEW MEXICO HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH320001

Entity Address

2211 Lomas Blvd NE
ALBUQUERQUE, NM 87106

Medicare Provider Number

320001

Participating Start Date

9/1/1993

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

WALGREEN ARIZONA DRUG CO

Pharmacy Address

DBA WALGREENS
2400 N WALGREEN STREET
FLAGSTAFF, AZ 86004

Pharmacy Comments

Contract Details

Approval Date

3/6/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/11/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ella B. Watt, CFO
(505) 272-1840

Contract Pharmacy Representative

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

Signed By Date

1/15/2013

340B Drug Pricing Program Database