Contract Pharmacy Details

WALGREEN CO
CH04023G AGAPE COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

AGAPE COMMUNITY HEALTH CENTER, INC.

Subdivision Name

AGAPE/Wesconnett Community Health Center

Type

HRSA-Funded Health Center

340B ID

CH04023G

Entity Address

5460 Blanding Blvd
Jacksonville, FL 32244

Grant Number

H80CS29456

Participating Start Date

10/1/2016

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #11580
1215 DUNN AVENUE, SUITE #2
JACKSONVILLE, FL 32218

Pharmacy Comments

Contract Details

Approval Date

4/15/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/24/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Mia L. Jones, CEO
(904) 760-4910

Contract Pharmacy Representative

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

Signed By Date

4/15/2020

340B Drug Pricing Program Database