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WALGREENS.COM, INC.
CH0418990 PRIMARY CARE MEDICAL SERVICES OF POINCIANA, INC.
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Covered Entity Details
Entity Name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA, INC.
Subdivision Name
PRIMARY CARE MEDICAL SERVICES OF POINCIA
Type
HRSA-Funded Health Center
340B ID
CH0418990
Entity Address
1877 Fortune Rd
Kissimmee, FL 34744-4428
Grant Number
H80CS30749
Participating Start Date
1/1/2009
Last Recertification Date
1/29/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WALGREENS.COM, INC.
Pharmacy Address
WALGREENS #02445
8337 S PARK CIRCLE
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/26/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Belinda Johnson-Cornett, CEO
(407) 414-9760
Contract Pharmacy Representative
Walgreens
Lisa Villarreal, Analyst, 340B Operations
(847) 964-6183
Signed By Date
1/10/2020
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