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WALGREEN CO.
FQHCLA356A 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
FQHCLA356A
Entity Address
981 37th Place
Vero Beach, FL 32960-6541
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 # 03110
692 SW PRIMA VISTA BLVD
PORT ST LUCIE, FL 34983
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
7/14/2020
Carve-In Effective Date
Contract Comments
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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