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WALGREEN ARIZONA DRUG CO.
DSH030006 TUCSON MEDICAL CENTER
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Covered Entity Details
Entity Name
TUCSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030006
Entity Address
5301 E GRANT ROAD
TUCSON, AZ 85712
Medicare Provider Number
030006
Participating Start Date
4/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 07463
525 W VALENCIA ROAD
TUCSON, AZ 85706-7636
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Karen Mlawsky, COO
(520) 324-3137
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2017
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