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WALGREEN CO.
FQHCLA356 Whole Family Health Center, Inc.
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Covered Entity Details
Entity Name
Whole Family Health Center, Inc.
Subdivision Name
Whole Family Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA356
Entity Address
725 N US Highway 1
Fort Pierce, FL 34950-9125
Grant Number
LALCS31468
Participating Start Date
10/24/2017
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04391
2501 VIRGINIA AVE.
FT PIERCE, FL 34981
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
7/14/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Marie Andress, CEO
(772) 925-8200
Contract Pharmacy Representative
Whole Family Health Center
Jamie Lynnette Merritt, Vice President
(772) 925-8200 Ext: 104
Signed By Date
7/13/2020
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