Contract Pharmacy Details

WALGREEN CO.
CH043823K BREVARD HEALTH ALLIANCE INC., THE

Covered Entity Details

Entity Name

BREVARD HEALTH ALLIANCE INC., THE

Subdivision Name

BHA Titusville Clinic

Type

HRSA-Funded Health Center

340B ID

CH043823K

Entity Address

1537 N Singleton Ave
Titusville, FL 32796-2759

Grant Number

H80CS04213

Participating Start Date

1/1/2011

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04259
4020 N WICKHAM RD
MELBOURNE, FL 32935

Pharmacy Comments

Contract Details

Approval Date

4/11/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Richard Austin Helton, CEO
(321) 241-6868

Contract Pharmacy Representative

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

Signed By Date

4/11/2019

340B Drug Pricing Program Database