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WALGREEN ARIZONA DRUG CO.
SCH030007-00 VERDE VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
VERDE VALLEY MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH030007-00
Entity Address
269 SOUTH CANDY LANE
COTTONWOOD, AZ 86326
Medicare Provider Number
030007
Participating Start Date
9/30/2010
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS #12385
475 W FINNIE FLAT RD
CAMP VERDE, AZ 86322
Pharmacy Comments
Contract Details
Approval Date
10/25/2012
Contract Begin Date
10/25/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GREGORY KUZMA, CFO
(928) 773-2006
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2012
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