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WALGREEN ARIZONA DRUG CO.
RRC030038-00 HONORHEALTH SCOTTSDALE OSBORN MED CT
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Covered Entity Details
Entity Name
HONORHEALTH SCOTTSDALE OSBORN MED CT
Subdivision Name
Type
Rural Referral Center
340B ID
RRC030038-00
Entity Address
7400 E Osborn Rd
Scottsdale, AZ 85251
Medicare Provider Number
030038
Participating Start Date
7/1/2019
Last Recertification Date
8/23/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 04046
3960 E CHANDLER BLVD
PHOENIX, AZ 85048
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
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
1/15/2018
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