Contract Pharmacy Details

WALGREEN CO.
STD333051 Midway Specialty Care Center

Covered Entity Details

Entity Name

Midway Specialty Care Center

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD333051

Entity Address

2608 NE 16th Avenue
WILTON MANORS, FL 33334

Grant Number

NH25PS005131

Participating Start Date

4/1/2018

Last Recertification Date

5/14/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05451
315 W. PLATT STREET
TAMPA, FL 33606

Pharmacy Comments

Contract Details

Approval Date

7/10/2018

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