Contract Pharmacy Details

WALGREEN CO.
RWII34982B Midway Specialty Care Center Inc

Covered Entity Details

Entity Name

Midway Specialty Care Center Inc

Subdivision Name

Type

Ryan White Part B

340B ID

RWII34982B

Entity Address

1801 SE Hillmoor Drive
C207
Port St Lucie, FL 34952

Grant Number

X07HA00057

Participating Start Date

10/1/2018

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04075
100 NW PARK STREET
OKEECHOBEE, FL 34972

Pharmacy Comments

Contract Details

Approval Date

8/22/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Moti Ramgopal, CEO
(772) 464-9746

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/10/2018

340B Drug Pricing Program Database