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WALGREEN CO
CH04023F AGAPE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
AGAPE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
AGAPE/WEST JACKSONVILLE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH04023F
Entity Address
120 King Street
JACKSONVILLE, FL 32204-2410
Grant Number
H80CS29456
Participating Start Date
4/1/2003
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
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