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WALGREEN CO.
STD32822 Two Spirit Health Services, Inc.
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Covered Entity Details
Entity Name
Two Spirit Health Services, Inc.
Subdivision Name
PremCare Family Medical Center
Type
Sexually Transmitted Diseases
340B ID
STD32822
Entity Address
4501 S. Semoran Blvd
Orlando, FL 32822
Grant Number
1H25PS004342-02
Participating Start Date
7/1/2019
Last Recertification Date
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03650
2420 E COLONIAL DRIVE
ORLANDO, FL 32803
Pharmacy Comments
Contract Details
Approval Date
7/2/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David Baker-Hargrove, President/Co-CEO
(321) 800-2922
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/2/2019
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