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WALGREEN CO.
CH043823K BREVARD HEALTH ALLIANCE INC., THE
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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 # 04816
1160 MALABAR ROAD SE
PALM BAY, FL 32907
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
Winn Dixie
David Chism, Senior Director
(904) 370-6455
Signed By Date
4/11/2019
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