Contract Pharmacy Details

WALGREEN CO.
RWII34982A Midway Specialty Care Center Inc

Covered Entity Details

Entity Name

Midway Specialty Care Center Inc

Subdivision Name

Type

Ryan White Part B

340B ID

RWII34982A

Entity Address

113 NE 19TH DRIVE
OKEECHOBEE, FL 34972

Grant Number

X07HA00057

Participating Start Date

10/1/2018

Last Recertification Date

1/28/2020

Entity Termination Date

1/1/2021

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

Contract Termination Date
Termination Reason

1/1/2021
Covered Entity Terminated

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