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WALGREEN CO.
DSH100007 AdventHealth Orlando
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Covered Entity Details
Entity Name
AdventHealth Orlando
Subdivision Name
Florida Hospital Orlando
Type
Disproportionate Share Hospital
340B ID
DSH100007
Entity Address
601 E. Rollins St.
Orlando, FL 32803-1248
Medicare Provider Number
100007
Participating Start Date
4/1/2012
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA:TEAM CARE
5881 TURKEY LAKE RD STE B2-02
ORLANDO, FL 32819-7747
Pharmacy Comments
Contract Details
Approval Date
10/13/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Myers, Senior Vice President Finance
(407) 303-5501
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2019
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