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WALGREEN ARIZONA DRUG CO
CH081650 CLINICA CAMPESINA FAMILY HEALTH SERVICES
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Covered Entity Details
Entity Name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Subdivision Name
Clinica Family Health- Administration
Type
HRSA-Funded Health Center
340B ID
CH081650
Entity Address
1345 Plaza Ct N
Lafayette, CO 80026-3531
Grant Number
H80CS00690
Participating Start Date
10/1/1995
Last Recertification Date
3/6/2018
Entity Termination Date
1/1/2019
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
3/4/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/6/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PETER LEIBIG, CEO
(303) 665-3036 Ext: 135
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2013
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