340B Drug Pricing Program Database
WALGREEN CO.
RWII32114 Outreach Community Care Network - information as of 4/29/2025 2:21:41 AM
Covered Entity Details
Entity Name
Outreach Community Care Network
Subdivision Name
Type
Ryan White Part B
340B ID
RWII32114
Entity Address
240 N Frederick Avenue
Daytona Beach, FL 32114
Grant Number
XO7HA00057
Participating Start Date
4/1/2013
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 12552
3805 S NOVA ROAD
PORT ORANGE, FL 32129
Pharmacy Comments
Contract Details
Approval Date
4/27/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Loretta Jennings, Executive Director
(386) 255-5569 Ext: 220
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/27/2016
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