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WALGREEN ARIZONA DRUG CO.
RRC030092-00 HONORHEALTH DEER VALLEY MED CTR
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Covered Entity Details
Entity Name
HONORHEALTH DEER VALLEY MED CTR
Subdivision Name
Type
Rural Referral Center
340B ID
RRC030092-00
Entity Address
19829 N 27th Ave
Phoenix, AZ 85027
Medicare Provider Number
030092
Participating Start Date
10/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 05851
5011 W UNION HILLS DR
GLENDALE, AZ 85308
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
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
1/12/2018
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