Contract Pharmacy Details

WALGREEN HASTINGS CO.
CHC08229-00 FIRST NATIONS COMMUNITY HEALTH SOURCE INC

Covered Entity Details

Entity Name

FIRST NATIONS COMMUNITY HEALTH SOURCE INC

Subdivision Name

First Nations Community HealthSource

Type

HRSA-Funded Health Center

340B ID

CHC08229-00

Entity Address

5608 Zuni Rd SE
Albuquerque, NM 87108-2926

Grant Number

H80CS08229

Participating Start Date

1/1/2015

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN HASTINGS CO.

Pharmacy Address

DBA: WALGREENS # 04649
3501 LOMAS BLVD. NE
ALBUQUERQUE, NM 87106

Pharmacy Comments

Contract Details

Approval Date

11/25/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/3/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Linda Son-Stone, CEO
(505) 262-6546

Contract Pharmacy Representative

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

Signed By Date

11/25/2014

340B Drug Pricing Program Database