Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO.
DSH030014 HONORHEALTH JOHN C. LINCOLN MED CTR

Covered Entity Details

Entity Name

HONORHEALTH JOHN C. LINCOLN MED CTR

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH030014

Entity Address

250 E Dunlap Ave
Phoenix, AZ 85020

Medicare Provider Number

030014

Participating Start Date

7/1/2015

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

WALGREEN ARIZONA DRUG CO.

Pharmacy Address

WALGREENS SPECIALTY PHARMACY #16431
2302 N. CENTRAL AVE.
SUITE 7
PHOENIX, AZ 85004

Pharmacy Comments

Contract Details

Approval Date

12/9/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Susan Moravec, AVP, Chief of Phamacy
(480) 882-5941

Contract Pharmacy Representative

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

Signed By Date

12/9/2016

340B Drug Pricing Program Database