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WALGREEN CO.
CH04023J AGAPE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
AGAPE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
AGAPE/Magnolia Jacksonville Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH04023J
Entity Address
5300 N Pearl Street
Jacksonville, FL 32208
Grant Number
H80CS29456
Participating Start Date
10/1/2016
Last Recertification Date
1/29/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03172
7512 LEM TURNER ROAD
JACKSONVILLE, FL 32208
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mia L. Jones, CEO
(904) 760-4910
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2019
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