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WALGREEN ARIZONA DRUG CO
CAH061327-00 Southwest Memorial Hospital
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Covered Entity Details
Entity Name
Southwest Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061327-00
Entity Address
1311 North Mildred
Cortez, CO 81321
Medicare Provider Number
061327
Participating Start Date
4/1/2012
Last Recertification Date
8/21/2024
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
2/26/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/17/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John M. Nadone, CFO
(970) 564-2153
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/28/2013
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