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WALGREEN ARIZONA DRUG CO.
RWII86305A Northland Cares
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Covered Entity Details
Entity Name
Northland Cares
Subdivision Name
Type
Ryan White Part B
340B ID
RWII86305A
Entity Address
107 West Frontier Road, Suite A
Payson, AZ 85541
Grant Number
X07HA00080
Participating Start Date
4/1/2016
Last Recertification Date
2/8/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 06666
2880 N CENTRE COURT
PRESCOTT VALLEY, AZ 86314
Pharmacy Comments
Contract Details
Approval Date
1/9/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/2/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Laurie Silver, Executive Director
(928) 776-4612 Ext: 14
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/9/2017
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